Health Transformation 12 Week Challenge

Powered by Integrous Wellness

First Name *

Last Name

Email *

Phone *

Are you an Integrous Wellness Affiliate? *

Who referred you to our 12 week challenge?

Where did you hear about this challenge?

2. What do you feel is the biggest obstacle holding you back from overcoming your pain points? Choose all that apply. *

Time

Burned out, Overwhelm

No support from friends or family

No support from a wellness or health professional

Too much conflicting information out there and don't know where to begin

Tried before and failed so afraid to attempt it again

Don't know what to eat or cook, need recipes

Know what to do, but hard to implement into daily routine

Other

5. What is your biggest frustration or fear when it comes to your health and wellness goals? If you chose “other” in the answers above, you can also elaborate on those in this section. *

By joining the 12 week challenge, you understand in order to qualify for any of the prizes, you must be on one of the product packs for the full 12 weeks. *

Our recommendation prior to starting the 12 week challenge is to get the following completed to achieve a starting baseline - Please choose which baselines you will be completing during this challenge

By signing below, you state that you are not pregnant or nursing and that you are at least 18 years old. *

Before starting any supplements or health challenge, we recommend you talk to your health care professional. *

"These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any diseases"

Signature *

Clear