Exit Wellness Question Title * 1. What is your First & Last Name? Question Title * 2. What is Your Email Address or Cell Phone that is best to follow up with? Question Title * 3. What are some concerns you have listed below Gut health Healthy aging Skin, hair, and nail health Immune support Focus/attention help Cleansing support Energy Level Other (please specify) Question Title * 4. How often do you exercise? Daily 1-2 times a week 3-4 times a week 5+ times a week Never Other (please specify) Question Title * 5. How much water do you drink daily? Question Title * 6. Do you have fruits & veggies daily? Yes No Other (please specify) Question Title * 7. Do you have trouble sleeping? Yes No Other (please specify) Question Title * 8. How would you rate your energy levels on a daily basis? 1-3 4-6 7-9 10 Other (please specify) Done