Detox Naturally — “Where Should I Start?
First Name
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Last Name
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Phone ( if you prefer to receive text notifications)
Email
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1. How often do you feel puffy, swollen, or retain water?
Often, especially in face or ankles
Occasionally
Rarely
2. How would you describe your urination patterns?
Frequent but incomplete or very dark
Inconsistent
Normal and consistent
3. Do you feel toxic, heavy, or inflamed but unsure where to start?
Yes, very much
Somewhat
No
4. Do you experience any of the following regularly? (Select all that apply)
Hormone imbalance
Headaches or nausea
Fatty food intolerance
Right-side rib discomfort
5. Have you taken medications long-term (past or present)?
Yes, multiple or long-term
Yes, short-term
No
Have you ever done a liver cleanse or flush before?
Yes, with good results
Yes, but it was hard
Never
7. How is your energy throughout the day?
Constant crashes
Some ups and downs
Stable
8. How consistent are you with supplements or wellness routines?
Not consistent
Somewhat consistent
Very consistent
9. Do you rely on caffeine or sugar to get through the day?
Yes, daily
Occasionally
Rarely
10. What level of commitment feels realistic right now?
Gentle and simple
Structured but flexible
Full lifestyle reset
11. How long can you commit to daily habits?
7-14 days
30 days
90 days
12. What are you hoping for most right now?
Relief and support
Better digestion & energy
Long-term transformation