Section 1
Contact information Section 2
What would you like to accomplish? Primary wellness goal Establish a healthier daily routine Receive general weight-management support Improve consistency and accountability Support my energy and daily activity Support hydration Support sleep and recovery habits Support stress-management and self-care habits Feel more confident Participate in the PHAT Girl Glow-Up Challenge Learn more before deciding Other
What other goals are important to you?
In your own words, what would a successful glow-up look and feel like for you?
Why is accomplishing this goal important to you right now?
Section 3
Your current routine How would you describe your current wellness routine? I am just getting started I start but have trouble remaining consistent I have a routine but want more support I am already very consistent I am not sure where to begin
How many days each week are you physically active? 0 days 1–2 days 3–4 days 5 or more days Prefer not to answer
How much water do you usually drink daily? Less than 32 ounces 32–64 ounces More than 64 ounces I do not track it Prefer not to answer
Which area is currently your biggest challenge? Consistency Nutrition habits Physical activity Hydration Sleep Stress Motivation Accountability Understanding products Other
Have you used wellness supplements or drops before? Yes No
Are you currently using a THREE International product? No Yes Not sure
If yes, which product or products are you using?
What approved THREE International products would you like to learn about?
Section 4
Your 30-day commitment Which habits would you like to track?
How ready are you to commit to your goals for the next 30 days? (7/10)
What type of support would help you most?
When would you like to begin? Today Within seven days Within 30 days I am only gathering information
What could make it difficult for you to remain consistent?
Section 5
Important health and safety screening Please do not share a diagnosis, prescription names, medical records, Social Security number, insurance information, or detailed medical history on this form.
Section 6
Communication preferences Section 7
Acknowledgments I confirm that I am at least 18 years old. I understand that PHAT Girl Drops, the PHAT Girl Glow-Up Challenge™, and THREE Brand Ambassadors do not provide medical advice, diagnosis, or treatment. I understand that supplements are not a substitute for medical care, a balanced diet, physical activity, or other healthy habits. I understand that individual experiences vary and that no weight-loss, health, wellness, or income result is guaranteed. I agree to review the complete product label, ingredients, warnings, and manufacturer directions before using a product. I understand that I should consult a qualified healthcare professional before using a new supplement if I am pregnant, nursing, taking medication, managing a medical condition, preparing for surgery, have allergies, or have health-related concerns. I understand that I should stop using a product and seek appropriate professional care if I experience a concerning reaction. I have reviewed and agree to the Privacy Policy and Terms and Conditions.
Your answers are private, transmitted securely, limited to authorized PHAT Girl Drops personnel, never shown in public community areas, and never sold or shared for unrelated advertising. You may request access, correction or deletion at any time — see our Privacy Policy and Terms and Conditions .
Please check every acknowledgment above to submit.