HEALTH AWARENESS CHART
How Do You Feel?
The consistent use of Youngevity products often brings about subtle changes in Wellness.
These changes can be so subtle that it is easy to forget what things were like before Youngevity
Before you begin you daily consumption of Youngevity products, please take a few moments to rate your health on a scale from 1 to 10 [1 = Very Poor 10 = Excellent] on the list.
Do this again after 1, 2, 3 and 6 months.
You can expect to see and feel improvements in your body, mind, emotions and spirit.
* Allow 2 minutes to complete this short questionnaire
Snapshot of how I feel now
{"name":"Health Awareness Chart","action_type":"0","optin_action_type":"5","form_redirect_type":"0","form_redirect_funnel_url":"next-funnel","form_redirect_custom_url":"","order_form_settings":{"containers":[{"id":"personal-info-wrapper","visible":true,"label":{"id":"of-personal-title","visible":true},"fields":[{"id":"of-full-name","setting":false,"placeholder":"Full Name"},{"id":"of-field-email","setting":false,"placeholder":"Email Address"},{"id":"of-phone-number","setting":true,"visible":false,"require":true,"placeholder":"Enter Your Mobile Phone","additional":{"sms_permission":0}},{"id":"of-gdpr-optin-approval","label":"I Accept To Receive Additional Info","placeholder":"","icon":"fa-mobile","required":0,"visible":0,"system":1,"additional":{"gdpr_optin_approval":"1"}}]},{"id":"shipping-information-wrapper","visible":false,"label":{"id":"of-shipping-title","visible":true},"fields":[{"id":"of-shipping-address","setting":false,"placeholder":"Address"},{"id":"of-shipping-city","setting":false,"placeholder":"City"},{"id":"of-shipping-state","setting":false,"placeholder":"State"},{"id":"of-shipping-zipcode","setting":false,"placeholder":"Postal Code"}]},{"id":"profit-bump-wrapper","visible":true,"otoBgColor":"rgba(219,229,239,1)","otoBorderColor":"rgba(38,71,102,1)","otoTitleBgColor":"rgba(45,78,108,1)","otoArrowsColor":"rgba(255,177,58,1)","fields":[]},{"id":"order-summary-wrapper","visible":true,"orderDynamicBgColor":"rgba(242,242,242,1)","orderDynamicTexColor":"rgba(51,51,51,1)","fields":[]}]},"optin_type":{"showLabels":1,"fields":[{"name":"first_name","label":"First Name","placeholder":"Enter Your Full Name","icon":"fa-user","required":1,"visible":1,"system":1,"additional":{}},{"name":"last_name","label":"First Name","placeholder":"Enter Your Full Name","icon":"fa-user","required":1,"visible":1,"system":1,"additional":{}},{"name":"email","label":"Email","placeholder":"Enter Your Email","icon":"fa-envelope","required":1,"visible":1,"system":1,"additional":{}},{"name":"mobile_phone","label":"Mobile Phone","placeholder":"Enter Your Mobile Phone","icon":"fa-mobile","required":0,"visible":0,"system":1,"additional":{"sms_permission":0}},{"name":"fields_labels","label":"","placeholder":"","icon":"","required":1,"visible":1,"system":1,"additional":{}},{"name":"captcha","label":"Captcha","placeholder":"","icon":"","required":1,"visible":1,"system":1,"additional":{}},{"name":"gdpr_optin_approval","label":"SSBBY2NlcHQgVG8gUmVjZWl2ZSBBZGRpdGlvbmFsIEluZm8=","placeholder":"","icon":"fa-mobile","required":0,"visible":1,"system":1,"additional":{"gdpr_optin_approval":"1","sms_permission":0}}],"customFields":[],"sortedFields":[{"name":"first_name","label":"First Name","placeholder":"Enter Your Full Name","icon":"fa-user","required":1,"visible":1,"system":1,"additional":{}},{"name":"first_name","label":"First Name","placeholder":"Enter Your Full Name","icon":"fa-user","required":1,"visible":1,"system":1,"additional":{}},{"name":"last_name","label":"First Name","placeholder":"Enter Your Full Name","icon":"fa-user","required":1,"visible":1,"system":1,"additional":{}},{"name":"email","label":"Email","placeholder":"Enter Your Email","icon":"fa-envelope","required":1,"visible":1,"system":1,"additional":{}},{"name":"mobile_phone","label":"Mobile Phone","placeholder":"Enter Your Mobile Phone","icon":"fa-mobile","required":0,"visible":0,"system":1,"additional":{"sms_permission":0}},{"name":"captcha","label":"Captcha","placeholder":"","icon":"","required":1,"visible":1,"system":1,"additional":{}}],"design":{"form_background_color":"rgb(245, 245, 245)","field_stroke":{"size":"1","color":"rgb(220, 220, 220)"},"field_icons":1,"button_color":"rgb(255, 158, 0)","button_stroke":{"size":"0","color":"rgba(255, 255, 255, 0.2)"},"button_box_shadow_color":"none","field_size":"small","label_size":"16","label_color":"rgb(0, 0, 0)","input_color":"rgb(52, 152, 219)","control_text_color":"rgb(0, 0, 0)","control_text_size":"15"},"mappedFields":[]},"redirect_type":{"url":"https://easethepain.net/simonsmith/hac","target":0},"next_step":{"value":"next-funnel"},"click_to_email":{"value":""},"click_to_call":{"value":""},"jump_to_block":{},"content":{"header_text":"PHNwYW4gc3R5bGU9ImZvbnQtc2l6ZToxOHB4OyI+UmF0ZSB5b3VyIGhlYWx0aCBvbiBhIHNjYWxlIGZyb20gMSB0byAxMCBbMSA9IFZlcnkgUG9vciZuYnNwOyAxMCA9IEV4Y2VsbGVudF08L3NwYW4+","content_text":"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","button_text":"PHNwYW4gc3R5bGU9ImZvbnQtc2l6ZToyN3B4OyBmb250LWZhbWlseTonb3BlbiBzYW5zJzsiPjxzcGFuIHN0eWxlPSJsaW5lLWhlaWdodDoxZW07Ij48c3Ryb25nPlRyYWNrIE15IFByb2dyZXNzPC9zdHJvbmc+PC9zcGFuPjwvc3Bhbj4=","spam_text":"PHNwYW4gc3R5bGU9ImxpbmUtaGVpZ2h0OjEuMmVtOyI+V2UgaGF0ZSBTUEFNIGFuZCBwcm9taXNlIHRvIGtlZXAgeW91ciBlbWFpbCBhZGRyZXNzIHNhZmU8L3NwYW4+","sms_text":"UmVjZWl2ZSBTTVMgVGV4dCBVcGRhdGVzIC0gPHNwYW4+b3B0aW9uYWw8L3NwYW4+","sms_text2":"SSBBY2NlcHQgVG8gUmVjZWl2ZSBBZGRpdGlvbmFsIEluZm8="},"email_confirmation":{"enable":1,"subject":"VHJhY2tpbmcgeW91ciBwcm9ncmVzcw==","message":"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"},"integrations":[],"automation_enable":0,"thank_you":{"type":"popup","redirect_url":"","popup_options":{"background_color":"#ffffff","headline_visible":1,"icon_visible":1,"icon_url":"//my.funnelpages.com/assets-pb/images/thankyou-popup-icon.png","subheadline_visible":1,"button_visible":1,"button_color":"#ffa800","headline_text":"PHNwYW4gc3R5bGU9ImxpbmUtaGVpZ2h0OjEuNGVtOyI+VGhhbmsgWW91IEZvciBDb250YWN0aW5nIFVzPC9zcGFuPg==","subeadline_text":"PHNwYW4gc3R5bGU9ImxpbmUtaGVpZ2h0OjEuNGVtOyI+UGxlYXNlIENoZWNrIFlvdXIgRW1haWw8YnIgLz5XZSBXaWxsIEJlIEZvbGxvd2luZyBVcCBTaG9ydGx5PC9zcGFuPg==","button_text":"Q2xvc2U="}}}
