Wellness Profile

1

Name

First Name

Last Name

2

Phone Number* This field is required.

Area Code

Phone Number

3

Email* This field is required.

example@example.com

4

Social Media * This field is required.

Instagram

Facebook

5

Check all that apply* This field is required.

LOSE weight

GAIN weight/muscle

I’m pregnant/a new mom and want a healthy pregnancy/ after birth

I want an extra income

6

How do you want to feel/look in the next 30 days ?* This field is required.

7

Have you ever tried Herbalife ? Is so, when?* This field is required.

8

How much are you willing to invest in your health to get started today ?* This field is required.

$25-$30 (3day trial)

$100-$150 (basic package)

$200-$250 (advanced package)

$300+ (ultimate pckage)

9

Do you have any friends or relatives that are wanting a better, healthier lifestyle ?* This field is required.

Yes, 1-5 people

Yes, 5-10 people

No

10

How can I better support you during your journey ?* This field is required.Explain what you struggle with , how can I help