Wellness Evaluation
Welcome and congratulations on taking the first step towards your goals with the #10DayWeightLossMarathon. To create a personalized eating and workout routine for you, we ask that you take your time to answer each question sincerely. Once you're done with the form we will reach out to you to answer any questions, and get you set up! 😉
Let us help you reach your goals! - Limited spots available
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Wellness Evaluation
*Required
Who told you about the 10 Day Marathon?
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Name
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First
Last Name
Phone Number
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Format: (000) 000-0000.
Email
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email@email.com
Address for Delivery
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City
State
Zip Code
Occupation
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What do you struggle the most with when trying to lose weight?
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What's the main reason you'd like to lose weight right now? (ex.; gained weight recently, wedding or vacation plans, health problems...)
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Wellness Evaluation
*Required
What time do you usually wake up?
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Hour
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min
AM
PM
AM/PM Option
What time do you usually go to bed?
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AM/PM Option
Where is your job located?
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City
What time are you daily meals and snacks?
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* Write every single meal from breakfast to late night snack. Example: Breakfast at 7am/ Morning snack at 9am (if any) / Lunch at 1pm / Afternoon snack at 4pm (if any) / Dinner at 7pm / Late snack at 10pm (if any)
How much water do you drink a day?
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Cups, oz or bottles
What's your worst food craving?
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The candy, fast food, or unhealthy food you crave the most, and you struggle with not eating it.
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Wellness Evaluation
*Required
How many people live with you?
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I live by myself
1 person
2 people
3 or more people
Have you ever tried any products from Herbalife Nutrition?
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Yes
No
If you answered yes, how long ago was you last purchase?
From 0 to 10, how committed are you to achieving your goal?
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0 not committed at all / 10 Very committed
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