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Wellness Consultation
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* Indicates required question
What’s your First and Last name?
*
Your answer
How would you like to be contacted? (Please include your phone number, Instagram handle, and/or email)
*
Your answer
Do you eat your fruits and vegetables on a daily basis?
*
Yes
No
Do you depend on caffeinated drinks to get you through your day? (Coffee, tea, energy drinks, etc.)
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Coffee
Tea
Energy Drinks/Preworkout
No
Other:
Required
Do you take any supplements already?
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Yes
No
Not consistently
Other:
Required
What are you looking to improve?
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Energy/Focus
Gut Health
Hair, Skin, and Nails
Mood
My daily intake of fruits and vegetables.
Other:
Required
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