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Detox Your Home

Detox & Personal Health Questionnaire

Here is a brief survey to help better understand you and your families needs and top concerns for a toxic free home and healthy lifestyle. After you submit it, we will set up a time to go over your results with a personalized one on one session. Don't worry it is 100% FREE!

Detox & Person Health Questionnaire

Name:

Email:

Phone:

How would you describe your wellness journey so far?

If you had to pick one area that was the most important to you what would it be and why?

Do you have any health concerns you would like to address for yourself?

How well do you sleep, and on average how many hours?

Do you have any health concerns for someone in your family?

How often does your family get sick?

How important is having safe effective cleaning products?

Very, it's at the top of my list

It's important, but not always top priority

Haven't thought about it much

Not important at all

How important is having safe skincare?

Very, it's at the top of my list

It's important, but not always top priority

Haven't thought about it much

Not important at all

How important is having safe personal products such as body wash and shampoo?

Very, it's at the top of my list

It's important, but not always top priority

Haven't thought about it much

Not important at all

How concerned are you about our environment?

Very, it's at the top of my list

It's important, but not always top priority

Haven't thought about it much

Not important at all

Do you like to prioritize saving money and finding the best deals?

Absolutely

Not at all

Somewhere in the middle

Are you concerned about your child(ren)'s toxicity level?

Yes

What's that?

Would you like to learn more about weight management?

Yes

Not right now

Would you like to learn more about a healthy diet, eating habits, and staying active?

Yes

Not right now

What brands do you commonly use in these areas of your home: Bathroom products, Kitchen, Laundry Room?

List the top 4+ stores you shop at in a 3 to 6 month time frame?

Thank you for contacting us.

We will get back to you as soon as possible to schedule a time to meet over zoom to go over your questionnaire.

We look forward to helping you.

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