Name
Leave blank if you don't want to share
First Name
Last Name
Email
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Gender
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Female
Male
Prefer Not To Say
Age
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18-29
30-40
41-50
51+
How would you rate your current stress level on a scale from 1 - 10?
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1 - Living in Paradise on Cloud 9
2
3
4
5
6
7
8
9
10 - If something doesn't give I'll end up a part of the explosions that happen every day around me.
What are your **top 3** stress-related concerns?
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Please only select 3 *top* concerns. It doesn't mean the others aren't concerns. I just want to know how you would prioritize them.
I can't enjoy anything because I'm always caught up in the crap going on in my head.
I can't sleep.
I'm always in a physical state of fight or flight - My body is constantly reacting to things and doing crazy crap without my permission - I don't even want to be stressed out but my body says otherwise.
I'm super short fused and my relationships are suffering because of it.
I feel detached from everything all the time - like I'm not even in fight or flight anymore.. I'm just.. frozen and distant.
Emotional eating - eating when I'm upset, happy, bored, stressed, or just generally can't stop when I enjoy something.
I keep finding myself attracted to the same type of people that put me in this stressed out state in the first place.
I'm noticing my body is hurting, my skin is breaking out, I don't feel good most of the time, and I'm going to the doctor a lot more but they tell me everything is in my head or just say I'm depressed and send me home with pills.
Something else that isn't listed here
What physical or emotional symptoms do you experience most often?
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What have you tried in the past to combat your stress and symptoms?
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How valuable do you consider the services we offer that helps you learn strategies for overcoming the entanglement of chronic stress, helps heal the mind, body, and spirit down to a cellular level, incorporates a nutritional plan for protecting the body, and provides a personalized roadmap and guidance for recovery and resiliency from daily stressors?
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Priceless! Take my money, I don't care how much!
It's important, but it would need to beat the price of my massages, hair, and nails.
Sounds great, but I'm skeptical - I'd need a demo first.
I have tried programs and they didn't work. I wouldn't pay for another.
Would you be interested in joining a program with other women that teaches you how to effectively manage your stress and heal your body from the damage it's caused?
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Answering "yes" does *not* commit you to a program - I am seeking to learn how popular it might be.
Yes
No
Do you want to see LS Wellness Solutions established as an oasis spot you can come to here in Sumter?
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I'm currently looking for a space that I can create a serene oasis with therapeutic rooms for specialized services and support! This will be used for group workshops and sessions, private sessions, and a small retail space.
Yes!! We need this!
No, I'm good with just online services.
Would you like to see this provided at your workplace?
Yes
No
Maybe
Any thing else you want to share?