II -RAFFI Institute Wellness Survey
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1. Please type your first name here: *
2. Please type your last name here: *
3. Enter the email address where you would like your essential oil recommendations sent here: *
4. What is your preferred way of communicating? *
5. Enter your phone number here:  *
6. What would you list or decribe as the #1 health challenge in you/your household or if all is well, your #1 wellness goal? (Examples of emotional, mental or physical challenges: stress, overwhlem, asthma, insomnia, weight loss, etc.) Examples of Wellness goals could be drink more water, increase excerise, build muscle, healthier eating, etc. If you are focusing on household, list family member and challenge, i.e. Frequent Colds - Daughter, Managing Stress - Me. *
7. What have you been trying to help with these challenges and/or goals? How has it been working for you? *
7. If you would like an essential oil sample sent to you, enter your mailing address here: (optional)
For Example:
Shannon Johnson
123 Main Street
Atlanta, GA 30324
United States
8. Any other questions for us? Any other comments you would like to share? If not, you can type 'NONE'.
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