1. What’s Your Biggest Challenge Right Now? *

I can’t sleep / My mind won’t stop racing

I’m in chronic pain (back, knees, joints)

I’m burned out and exhausted constantly

I want to look/feel younger (anti-aging)

I’m an athlete needing faster recovery

I’m stressed and anxious all the time

I have respiratory issues (asthma, allergies

I get sick frequently / weak immune system

2. How Long Have You Been Dealing With This? *

Less than 3 months

3-12 months

1-3 years

More than 3 years

3. What Have You Already Tried (Multiple Selection)? *

Medications/prescriptions

Physical therapy or chiropractic

Meditation or yoga

Diet changes

Exercise programs

Supplements

Nothing yet - this is my first step

Everything - I’m desperate for a solution

4. What Would Success Look Like for You (Multiple Selection)? *

Sleeping through the night without waking up

Waking up pain-free and energized

Having energy to enjoy life again

Feeling calm and in control

Looking in the mirror and feeling confident

Performing at my peak athletic ability

Breathing easily without medication

Not getting sick every month

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First Name *

Last Name *

Email *

Phone *

SMS Opt-in *

Yes, text me my results immediately

No, I do not want to receive any texts from SoliVana

5. When Do You Want to Start? *

This week - I’m ready now

Within 2-4 weeks

Just researching options

6. What’s Most Important to You (Multiple Selection)? *

Science-backed, proven results

Natural, drug-free solutions

Fast results - I can’t wait months

Long-term transformation, not quick fixes

Privacy and a peaceful environment

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