Full Name *

Email *

Phone *

Which of the following best describes you?

Male

Female

How well do you feel you prioritize self care in your life? *

What's self care?

I'm not sure, I like to think I do sometimes

I never have any time for self care!

When I do it, I do it well, but it's not always the first priority

I'm a pro at investing in myself daily

How often would you say you exercise?

I don't exercise

Maybe once a month

1-2 times per week

3-4 times per week

5-7 times per week

How is your mood on a typical day?

Not the best

Ok

Calm

Determined!

Happy :)

Which of the following self care activities do you do on a regular basis?

Prayer/Meditation

Practicing Gratitude

Affirmations

Visualization

Breath Work

Grounding

Skincare

Getting Ready In The Morning

Daily Routines

Exercise

Meal Prepping

Budgeting

Evening Baths/Spa Days

Massages

How much water do you drink in a day?

Maybe a few cups, I'm not sure...

32 oz

64 oz

96. oz

A WHOLE GALLON!

Now, how well do you feel you prioritize self care on a regular basis?

I don't do any self care

I am not great at prioritizing self care

When I do it, I do it well, but I don't always make it the first priority

I'm a pro at investing in myself daily!

If I offered you exclusive self care experiences from time to time, would you be interested?

Yes, that sounds great!

No, not at this time

Would you be interested in connecting with me on a call for a custom self care plan? *

Yes, I'd love to hear more details

Not right now, thanks

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