Information assessment:
Thank you for completing this assessment it will help to better assist you on your journey.
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail address *
What's your Instagram username? *
What Country/State are you located in?
Have you ever tried using Supplements before? If yes,how long ago?
*
Have you ever been a member of a. Supplement sales company ? If so, how long ago? * Are you still a member there?
Best Contact Time
8am-11am
11am-2pm
2pm-5pm
5pm-8pm
age range*
CHOOSE
18-25
26-32
33-41
42-50
51+
HEIGHT*
4'10" - 5'1"
5'2"-5'5"
5'6"-6'1"
6'2"-6'5"
6'6"+
Weight*
Check all that apply?
*
I want to eat better and have a healthier lifestyle
I want to lose 5-15lbs
I want to lose 15-30lbs
I want to lose 30+lbs
I want to lose belly fat and tone up
I want to gain lean muscle
I am currently a breastfeeding mom and want to get results.
I am currently pregnant and want to have a healthy pregnancy.
I want to know more about the Herbalife business opportunity.
I am an athlete and want to enhance my performance
I want more energy
I want great skin
Would you be interested in earning additional income as well as achieving your health goals?
Yes
Not Yet
Do you skip meals
Yes(I frequently do)
Yes (I sometimes do)
Not often
I never skip meals
How many times a day do you eat? (include meals & snacks)
How much money do you spend on eating daily?
$5-$10
$10-$20
$20 (I at like a boss)
Do you have friends/family that need nutrition, to get in shape or would like some kind of result?*
Yes 1 person
Yes 2 -3 people
Yes 3-5 people
Are you interested in test driving Herbalife Nutrition for 3 days and joining the 3 day challenge?
Yes
No
Are you looking to join the 21 day challenge?
Yes
No
How serious are you about achieving your goals?*
VERY SERIOUS I want to start right now!(ONLY SELECT IF YOU WANT TO START TODAY!)
Serious I want to start this week
A little serious I want to start this month
Type option 4
My Products
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Single serve Shakes Aloe Teas Mega Teas 3 day Trial Packs
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Free
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Total
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Payment Methods
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