Wellness Questionnaire

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Filling out this form will help Nikki from Young Living Essential Oils best know how to serve you.

Have you used Essential Oils Before? *

Yes

If yes, which oils have you used previously? *

Young Living

DoTerra

Other:

If you answered "other," please type the names of the oil company or companies that you've used.

If you have used Young Living Oils, Home or Personal Products in the past, please check all that apply

I have never been a Young Living Member

I have been a Young Living Member in the past, but its been more than 6 months since I've ordered.

I've been a YL Member in the past, but its been over a year since I've ordered

I've never been a YL Member, but have a friend or family member who orders for me on their account

I've never been a YL Member, but have used the oils because someone gave them to me to try or as a gift.

I am currently an active Young Living member. I have ordered within the last 6 months.

What categories related to health and wellness are important to you? Check all that apply. *

Physical Wellness

Emotional Wellness

Healthy Children

Making my home smell good with toxin-free products that are safe for my family

Cleaning my home with products that are safe for me & my family / non-toxic

Using body & personal products that are safe for me & my family / non-toxic

Having trustworthy resources available regarding health and wellness

Being able to reach out to others regarding my health and wellness with questions or for help

Swapping out the toxin-filled cleaning and body products in our home for family-safe ones

Belonging to a community of encouraging people focused on health and wellness.

Getting to the root cause of an issue related to emotional or physical wellness

Other:

Required

Please type here any questions that you may have regarding using essential oils, home cleaning products, personal care products, or any other questions about physical and / or emotional health & wellness that you may have. This will help me to prepare for our conversation when we meet up to chat.

Please type your name, phone number & email address, so that I can contact you, if needed.

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