Skincare Wellness Survey

Welcome to the Clean & Simple Wellness Survey!

This quick survey helps me understand your personal wellness goals—whether it’s skincare, nutrition, or creating a clean, safe home.

Answer as many questions as apply to you so I can share simple, personalized suggestions that truly fit your needs.

My goal is to offer value, clear up misconceptions, and help you feel confident in your choices.

Let’s get started!

Short: Clean & Simple Wellness Survey (#21)

First

Last

Phone

Address (fill out if you want samples mailed to you)

Street Address

Address Line 2

City

State / Province

ZIP / Postal Code

What’s your Shaklee status?

I love Shaklee – I use many products.

I think I’ve heard of Shaklee from a family member.

I’ve never tried Shaklee before.

I want to introduce Shaklee to my friends in an online or in-person educational setting.

I want to see if I qualify to be a Brand Ambassador.

Which health goal is most important to you right now?

Boosting energy Managing weight Improving digestion Supporting overall immunity

Improving digestion

Managing weight

Supporting overall immunity

Glowing healthy skin

Using Eco-friendly cleaning products to reduce toxins

OR is it all of the above?

How often do you use nutritional supplements?

Daily

A few times a week

Occasionally

Never

What’s your primary skin concern?

Active Acne

Dryness

Fine Lines and Wrinkles

Uneven Skin Tone

Other

No Major Concerns – Interested in Safer Products

If ‘other’ – describe your concern

Which of the following best describes your skin type?

Oily: Your skin tends to be shiny and may be prone to acne or blackheads.

Dry: Your skin often feels tight, flaky, or rough.

Combination: You experience a mix of both oily and dry areas on your face.

Normal: Your skin is balanced, not too oily nor too dry.

Sensitive: Your skin is prone to redness, irritation, or allergic reactions.

Do you currently use eco-friendly cleaning products?

Yes, exclusively

Some, but not all

No, but I’m interested

No, it’s not a priority

What’s your top priority for cleaning products?

Effectiveness

Safety for family and pets

Saving time

Affordability

Eco-friendliness

All of the Above

What does “contentment” in your wellness journey mean to you?

Feeling confident in my health choices

Having more energy for what matters

Creating a safe and clean home environment

All of the above

Please list any other concerns or questions you might have here. Happy to help!