Young Living Essential Oils | Health & Wellbeing Assessment

Young Living Well-Being Assessment

This assessment is here to guide you on rating your current state of well-being.

* Indicates required field

Name *

First

Last

Email *

City, State, Country *

Phone Number and/or Skype *

Time Zone *

Are you familiar with therapeutic-grade essential oils and have you ever used them before? *

Yes No

Feel free to tell me more *

On a scale of 1 - 10, how would rate your level of physical well-being at this time? *

1 2 3 4 5 6 7 8 9 10

Share with me where you would like it to be instead. Include any current physical ailments or challenges, etc. *

On a scale of 1 - 10, how would you rate your mental well-health at this time? *

1 2 3 4 5 6 7 8 9 10

Where would you like it to be? ie - more clarity, peace and calm, less stress, anxiety, etc. *

On a scale of 1 - 10, how would you rate your emotional well-being at this time? *

1 2 3 4 5 6 7 8 9 10

Where would you like it to be? *

On a scale of 1 - 10, how would you describe your spiritual well-being? *

1 2 3 4 5 6 7 8 9 10

Where would you like it to be? *

In thinking of the area that is of most importance to you, what have you tried in the past, and how did that work out for you? *

What will your life look like after this area of concern is resolved? *

What is your current budget for investing in solutions for you personal physical, mental, emotional and spiritual well-being? *

What time frame would you like to see these changes installed by? *

A few weeks 3 months 6 months 1 year

On a scale of 1 - 10, how motivated are to create these life changes? *

1 2 3 4 5 6 7 8 9 10

Would you be interested in a one-day intensive? *

If you are in a country other than the US, do you have access to Skype? *

Yes No I prefer to use my phone

Submit

After clicking "Submit", you'll be led to my on-line calendar, where you can make a 30-minute, complimentary appointment to review your thoughts and goals on your well-being. Thank you ~

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