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4 to 10 Day Cleanse Workshop Sign-Up Quiz
A quiz to assess knowledge and preferences about the 4 to 10 Day Cleanse Workshop.
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* Indicates required question
Full Name
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Preferred Cleanse Duration
*
4 Days
5 Days
6 Days
7 Days
8 Days
9 Days
10 Days
Have you done a cleanse before?
*
Yes
No
Do you have any dietary restrictions or allergies?
Your answer
What are your wellness goals for this cleanse?
Your answer
How did you hear about this workshop?
Choose
Social Media
Friend/Word of Mouth
Website
Other
Are you currently taking any medications or have any medical conditions we should be aware of?
Your answer
Do you have any prior experience with fasting, juicing, or detox programs?
*
Yes
No
Preferred Contact Method
*
Email
Phone
WhatsApp/Text
Emergency Contact Name & Phone Number
*
Your answer
Would you be interested in future wellness workshops or retreats?
Yes
No
Maybe
Clear selection
Any additional comments or questions?
Your answer
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