Health Goals Survey
We are so excited to help you put together your three month wellness plan. Your responses below will help us!
Email address *
Name *
Your answer
Member # *
Your answer
First - Third Health Goals in order of priority
1st health goal: *
Your answer
2nd health goal: *
Your answer
3rd health goal:
Your answer
What is your monthly budget to work on these three things? (Must be $50 or above if joining Essential Rewards)
Your answer
I prefer to discuss my health goals and plan via.... *
What health practices are you currently doing for these goals?
Your answer
Anything else you would like me to know before I create your health plan?
Your answer
What is your first and secondary Color personality?
Your answer
What is your first and second Love Language?
Your answer
Are you currently on Essential Rewards? *
Do you need more information on Essential Rewards (ER)? *
Are you willing to join Essential Rewards for 3 months to focus on your health? *
I am READY to take control of my health and I am ALL IN! *
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