Customer Consultation Form

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Because we are serious about customer service and value your feedback, we would appreciate a moment of your time to better understand your interest in hemp-based products. To be clear, ALL questions are optional, however the more information we can gather will help us make informed decisions as we develop products and services to meet your needs. And don't worry, we will not be sharing ANY of your personal information beyond this consultation screening. We know the ONLY way to gain your loyalty is to earn your TRUST. Thanks for taking the time and we look forward to serving you again in the near future!

Name (first name only)

Gender

Female

Male

Prefer not to say

Other:

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Age

Under 18

18-29

30-49

50-65

65+

Prefer not to say

Clear selection

What condition are you seeking relief from today? (check all that apply)

Nerve/Joint Pain (arthritis, neuropathy, back)

Anxiety

Depression

Digestive Issues (chron's, colitis, reflux)

Skin Care

Cancer

Neurological Issues (migranes, multiple sclerosis, parkinson's)

Vascular Issues

Withdrawal

Other:

Where do you experience most of your issues? (check all that apply)

Everywhere

Head, Neck

Arms, Legs

Hands, Feet

Chest

Abdomen

Other:

Have you used hemp products before?

Yes

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Have you visited Advanced Hemp in the past? If so, thanks for coming back!

Yes

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What types of products are you most interested in? (check all that apply)

Tinctures

Topicals

Capsules

Edibles

Concentrates

Smokes

Other:

Resources & Savings

Advanced Hemp recently partnered with Leafly to become their FIRST CBD Store listing in Pennsylvania! Leafly is THE go to source for all things hemp from retail menus and daily updates to cannabinoid and terpene profiles. If you're new to hemp, this is a great place to begin your education along with our personal consultations. Don't worry, you don't have to take the hemp journey alone. By providing your email address below, you will enlist in our Leafly partnership program to receive the most up-to-date information on our store and all things hemp. The Leafly platform is a great way for you to go read, browse, and schedule a pickup on the go! We look forward to you joining the Leafly family and helping you save 10% OFF your next purchase!

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