Wellness Survey

Fill out Wellness Survey and Receive $50 Gift Card*

Thank you for taking the time to fill out this Wellness Survey. Just for filling out the information, I will give you a $50 Gift Card that can be applied towards TriVita’s high quality products. They have over 50 quality wellness products that support weight management, muscle health, energy, stamina and performance, heart health, bone and joint health and even brain health.

With the $50 Gift Card, you get to choose the products based on your own personal needs and interests. There are no catches, no obligations and no fees. You are only required to pay the shipping, handling and taxes. (The $50 Gift Card is for U.S. only and Canada first-time customers only. If you are a returning customer, contact me to learn of a wonderful unique alternate benefit that is only for established customers.)

To your health!

Independent TriVita Business Owner Peggy Polonus #13873775

1. Please enter your name and email address

2. Do you feel like you are at your optimum in wellness?


3. Are you concerned with your health/wellbeing on a regular basis e.g. using the internet to search for health / medical information, reading the health section in newspapers/magazines, taking vitamins and supplements etc?


4. Do you take nutritional supplements?


5. When purchasing supplements (or if you were planning on purchasing supplements), which of the following do you take into consideration:


6. Which categories would you be most interested in:


7. If there were remote services, like bioenergetics available that could help assess your health, would you be interested?


8. What areas of your health would you like to improve?

9. After you submit your results below, you will be qualified for the $50 Gift Card.

Please let me know the best way to reach you to send you your $50 Gift Card.  You can provide your email address, phone number or both.  You can also reach me anytime by calling 706-583-9111.