Survey Questions

Please select the answers that best fit you.

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* 1. First & Last Name

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* 2. What country do you live in?

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* 3. What is your primary wellness concern?

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* 4. Are there any secondary concerns?

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* 5. Please add any additional questions or information here

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* 6. How can I contact you with your results? (Phone number, email, Instagram tag)

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