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Simple Health Solutions
About Me
Health Assessment
I'd love to learn about you and help guide you on your journey to feel your best! Serious inquiries only, please.
First Name & Last Name
What is the best way for me to get in contact with you?
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Text Message (U.S. Only)
WhatsApp
Email
Facebook/Facebook Messenger
Instagram/Instagram Messenger
Email
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Phone Number
What country are you in?
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USA
Australia
Canada
Mexico
New Zealand
Other
How did you find me?
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Facebook
Instagram
TikTok
Other
**If you are here from Facebook, Instagram or TikTok, please provide your profile link
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Which of the following best describes the area of health you want to focus on most?
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"I need energy! I feel so drained most of the time."
"I'd like to maintain my weight in a HEALTHY way. I'm tired of quick fixes and diet fads that don't work."
"I'd like to maintain my weight in a HEALTHY way. I'm tired of quick fixes and diet fads that don't work."
"I'm looking for something help my WHOLE FAMILY stay healthy year round."
"I'd like to focus on the health of my skin. Give me all the beauty benefits."
Check all that apply below when it comes to your current health goals or concerns:
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Weight Management
Cravings
Overeating
High intake of carbs/sugars/alcohol
Autoimmune symptoms
Headaches/Migraines
Constipation
Easily Upset stomach/Frequent diarrhea and urgency
Bloating, gas
IBS-D, Chrohn's, Ulcerative colitis, or other IBD's
Heartburn/Acid Reflux
Chronic fatigue
Low energy
Sleep problems
Mood Swings/Irritability
Lack of concentration
ADD/ADHD
Mood disorders - Depression/Anxiety
Thyroid dysfunctions
Seasonal allergies
Unhealthy Blood pressure
Inflammation
Frequent Infections
Hormone imbalance
Menopausal symptoms
Are you currently using any prescription drugs to treat any of the above? Please specify:
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If you decide get started on your journey to better health, which of the following best describes you?
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Retail Customer - Full Price - No Account Benefits (FYI - Not many people purchase this way - you pay a lot more for a lot less and there isn't really much more to being a VIP)
VIP Customer - 40-50% off 1st Order; 25% off going forward; option to earn free product credit with a referral link.
Cash Referral VIP Customer - All the benefits of a VIP Customer, but when you refer someone, you earn cash bonuses instead of free product credit, and you earn more + a recurring payment when your referrals reorder. (Refer 3 - earn $405 USD).
Cash Referral VIP Customer - All the benefits of a VIP Customer, but when you refer someone, you earn cash bonuses instead of free product credit, and you earn more + a recurring payment when your referrals reorder. (Refer 3 - earn $405 USD)
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