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Essence Health & Wellness Survey
First name
*
Email
*
Birthday
*
Month
Day
Year
Phone #: Include 1 before your 10-digit number (e.g., 1XXXXXXXXXX)"
City/State
*
I have a high-level understanding of what nutritious eating and healthy living looks like.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Where I live, I have consistent access to affordable, healthy, and nutritious food options.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I have access to affordable natural body and personal care products.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I would like to learn new and effective practices for eating healthier and living sustainably.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I currently experience health-related issues or have ongoing health concerns.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I would pay for consistent access to healthier food options, natural body products, and wellness education.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I would pay to have access to a sustainable garden or for one to be built/maintained for me.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I believe that introducing healthier living and sustainable practices into my everyday life & community would create lasting and positive change.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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