Your results will be emailed to you in 1-2 business days.

25 Questions (20-45 minutes)

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Contact Info

Name(required)

Email(required)

About You (6 questions)

1. Is this quiz for yourself or someone else?(required)

Myself Only

Someone Else

2. Age in Years:(required)

0-2

3-5

5-10

10-18

18-25

25-35

35-50

Over 50

3. Gender and Pregnancy Status: (required)

Male

Non-Pregnant Female

Planning/Pregnant or Breastfeeding Female

Other

4. Nightly Sleep Average (Past 12 Months):(required)

4 hours or less

5-6 hours

6-7 hours

8-10 hours

12+ hours

5. Average Stress/Anxiety Level (Past 12 Months):(required)

Not Anxious or Stressed At All

Rarely Anxious or Stressed

Moderately Anxious or Stressed

Very Anxious or Stressed

Extremely Anxious or Stressed

6. Major Life Changes, Significant Stresses, or Traumatic Events (Past 12 Months):(required)

Goals & Challenges (6 questions)

7. What needs improvement? (one or more)(required)

Hair Scalp Body Skin Facial Skin

8. List All Specific Skin/Hair Care GOALS (describe in as much detail as possible):(required)

9. List All Specific Skin/Hair Care CHALLENGES (describe in as much detail as possible):(required)

10. Are you willing to stop using your current products to replace them with our products to get the results you are looking for?(required)

Yes

11. Are you willing to learn new self-care techniques that may take some extra time, practice, and patience to get the results you are looking for?(required)

Yes

12. What is your monthly budget for skin/hair care products to get the results you are looking for?(required)

$50 or less

$50-$100

$100-$200

Over $200

Product Preferences (9 questions)

13. Looking for any specific ingredients or products to try, and WHY?(required)

14. Absolutely avoiding any specific ingredients or products, and WHY?(required)

15. List ALL products currently using on the skin and/or hair INCLUDING BRAND NAMES and WHY?: (details such as frequency and amount used are helpful)(required)

16. What do you like AND dislike about these products? (details such as results, price points, ingredient preferences, shopping ease, and convenience are helpful…)(required)

17. What products have you used in the past that did not work INCLUDING BRAND NAMES and WHY? (include as much detail as possible)(required)

18. Scent Type Preferences: (one or more) (required)

Unscented (none or natural) Essential Oils Fragrances (NO phthalates or parabens)

19. Scent Style Preferences: (one or more) (required)

No Scent Feminine Unisex Masculine

20. Scent Strength Preferences: (one or more) (required)

Unscented Light Medium Strong Heavy

21. Perfect scent satisfaction is not guaranteed for everyone, but we do our best with your help. Describe your current favorite scent preferences for each type of product you are looking for. If scent type/style/strength depends on the product type, define these now:(required)

Medical Data (4 questions)

22. Any known allergies, reactions, or sensitivities?(required)

23. Any Types of Specialists Seen and When? What were the recommendations and results? (describe in as much detail as possible):(required)

24. Current Medical Conditions Diagnosed by a Licensed Medical Professional? (describe in as much detail as possible):(required)

25. Current Medications/Supplements with Dose and Frequency (both prescribed and over-the-counter):(required)

By submitting your information, you’re giving us permission to email you. You may unsubscribe at any time.

We will do our best to get back with you within 1-2 business days after submission!

Phone Consultation Request

If you are wanting to speak with a representative outside of our business hours, please fill out the request below.

Or call (812) 414-9735 during our business hours: Monday-Friday, 8am-4pm EST (not including holidays)

By submitting your information, you’re giving us permission to call/text you from our personal or work phones.

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Name(required)

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Phone(required)

Date (YYYY-MM-DD)(required)

What Time Would Be Best To Talk (YOUR TIME)? Please avoid 9pm-6am EST, weekends, and holidays.
If for some reason our experts are not available at your request, we will schedule another date/time with you!

Thank you for your response. ✨

Contact Info

About You (6 questions)

Goals & Challenges (6 questions)

Product Preferences (9 questions)

Medical Data (4 questions)

Phone Consultation Request

Thank you for your response. ✨

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