Adams Customer Needs Assessment
To get started let's make sure we have your basic info.
Email
example@example.com
Please provide your name:
First
Last
What is your mailing address?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current buying habits
The following sections ask you about your current buying habits. Please be as specific as possible.
Any problems/pains/complaints that you would like to share that you are currently seeking solutions for?
LAUNDRY
Let's start with those clothes.
Do you use liquid or powder detergent?
Liquid
Powder
Other...
What brand do you most often use for laundry detergent?
*
Check all products that you currently use:
Fabric Softener
Bleach
Pre-wash/Stain remover
Other
What is most important to you regarding your laundry products? (chemical free, natural, environmentally safe, quality, cost, brand awareness, effectiveness, etc.)
SURFACE CLEANERS
Cleaning your counters, bathrooms, & windows can be a chore. Let's discuss!
Check all thee products that you currently use:
Bathroom
Glass cleaner
Kitchen
Multi-purpose
Disinfectant
Wipes
Other
Is there anything you wish you could change about the surface cleaners that you currently use?
What is most important to you regarding your surface cleaners? (disinfecting, chemical-free, natural, convenient, environmentally safe, quality, cost, brand awareness, fragrance, effectiveness, etc.)
HAIR CARE
Check all the specific hair treatments you currently use (whether shampoo/conditioner/etc.)
Color repair
Extra volume
Smooth moisture
Shine spray
Hairspray
Curl cream
Straightening balm
Hair mask/repair
Other
What brand(s) of hair products do you currently use?
Is there anything you wish you could change about the hair products you currently use?
Makeup & Cosmetics
What do you currently use for your foundation/face make-up?
Primer
Concealer
Liquid foundation
Powder foundation
Combination foundation
Color correcting cream
Contour / highlighter
N/A
Other
Checek all of the following that you currently use for your eye makeup:
Eyelash primer
Mascara
Eye liner - liquid
Eye liner - powder
Eye shadow - liquid
Eye shadow - powder
Eye cream
Color corrector
Other
What's most important to you about your lip care?
Color
Volume
Softness
All of the above
Other
SKINCARE
Your skin is actually your largest organ and it demands your attention!
What brand do you currently use for your face cleanser?
What brand do you currently use for your moisturizer?
Why did you choose the brand(s) that you use?
Are there any targeted treatments you have had in the last 6 months?
Are you currently seeking any targeted treatments?
Yes
No
Maybe
Nutrition & Weight Management
Select all that you currently use:
Meal replacement
Shakes
Snacks
Supplements
Protein powder or drinks
Other
Check all the vitamins & supplements that you currently use:
Generic multi-vitamin
Men's or women's multi
Children's multi
Heart health
Vision
Focus
Digestive health
Joint health
Brain health
Immunity
Energy
Other
What brand do you typically buy and why?
Check all sports nutrition products that you currently use or have interest in learning about:
CBD spray/cream
Energize (healthy energy edibles, pre-workout, energy/focus
Protein powder
Recovery
Hydration
Pre-workout
Other
Water & Air
Because no matter who we are or where we come from, we all expect the basic human rights of clean air to breathe, clean water to drink, and healthy land to call home.
If so, what brand? Is it whole-home or just for your fridge/kitchen sink?
If so, what brand? Is it whole-home or just a standalone unit?
Customer Account
We would love to set you up with a customer account to make purchasing easier. This also gives you access to a loyalty program where we reward frequent buyers. This account is 100% free and can be set up in minutes!
Preferred email address?
example@example.com
Phone Number?
Please enter a valid phone number.
Birthday?
-
Day
-
Month
Year
Date
Submit
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