Gaining Even More (order form)

Question Title

* 1. What is your name?

Question Title

* 2. What is your textable phone number?

Question Title

* 3. What is your email address (for your invoice and product information)?

Question Title

* 4. How did you hear about Gaining Even More (GEM)?

Word of Mouth

Dr. Staci Adams

Social Media

Other (please specify)

Question Title

* 5. Would you like to order GEM Deep Conditioning Packs?

Not at this time

Yes please, ONE for $30

Yes please, TWO for $50

Yes please, FOUR for $90

Other (please specify)

Question Title

* 6. Would you like to order GEM Nourishing Drops?

Not at this time

Yes please, 15 mL for $30

Yes please, 30 mL for $50

Yes please, 60 mL for $100

Yes please, 120 mL for $190

Yes, please 235 mL for $380

Other (please specify)

Question Title

* 7. Are you currently experiencing scalp issues?

Yes

If yes, please explain

Question Title

* 8. Briefly describe your hair goals.

Question Title

* 9. Are you TTC, pregnant, or nursing (answers alter ingredients in your personalized mix)

Yes, I am TTC / pregnant

Yes, I am nursing

Other (please specify)

Question Title

* 10. Are you interested in consultation services? If so, please explain

Not at this time

If YES, please explain

Question Title

* 11. Would you like to buy a T-shirt?

No, Thank you.

If YES, what size?

Question Title

* 12. To update your order with accurate shipping estimates, please provide a shipping address (no P.O. Boxes, please)

Please text, "GEM ORDER SENT" to confirm receipt of your order, to (404) 791-4396.