Consultation RequestForm

Please submit as detailed information as possible so that we may fill your needs.  Ebay & Other Goods stands by to provide all your needs in the holistic arena.

Just send us a message if you are interested in a health or beauty consultation and we will get back to you right away.

* Indicates a required field

Name:*

Company:

Phone:*

Fax:

E-Mail:*

Address:

City:

State:

Zip Code:

Country:

Additional Address info:


Favorite Brand Name products used:
Hauschka
ZIA
Avalon
derma e
Jason Natural Cosmetics
Oil of Olay
Neutrogena
Other
Not Applicable

Type of Consultation desired:
Facial Care
Body Care
Makeup
Vitamins and Supplements
General Beauty
General Health
Exercise
Spirituality and Meditation
Other
Not Applicable

Category of Service Interested in (check one or more):
Health
Beauty
Anti-Aging
Exercise
Other

Type of Client:


Description of requested service:

Optional Description or Comments: