Page 1 of 2

30-Day Personalised Natural Wellness Plan

Complete this short questionnaire so we know more about your specific situation and we will send you your personalised plan.

What is your Age?

*

A

Under 40

B

40-49

C

50-59

D

60-69

E

70-79

F

80+

What Are You Currently Dealing With?

*

Select all that apply

Arthritis

Migraines / Headaches

Psoriasis

Eczema

Joint Pain / Stiffness

Muscle Pain / Soreness

Back Pain

Sleeping Issues

Hormonal or Menstrual Issues

How long has this affected your life?

*

A

1–6 months

B

6–12 months

C

1–3 years

D

3–5 years

E

5+ years

How often does it affect you?

*

A

Occasionally

B

Most Days

C

Every Day

D

Constantly

When is it usually at its worst?

*

A

When I wake up

B

During the day

C

At night

D

After physical activity

E

After sitting for long periods

F

After standing for long periods

G

Other

In your own words, how does this affect your life and what would you most like to be able to do again?

*

For example: walking, sleeping, working, gardening, exercising, spending time with family, household tasks, etc.

Are you currently on Blood Thinning Medication?

*

A

Yes

B

No

Are you currently taking any prescription medications?

*

A

Yes

B

No

What is your Name, Email and Phone Number?

Please provide your contact details so we can send you your Personalised Plan!

Name

*

Email

*

Phone Number

*

Untitled checkboxes field

Yes, I’d like Aussie Legends Hemp to email me my personalised Wellness Plan and helpful follow-ups. I can unsubscribe at any time.