Wellness Profile
This profile helps us better understand your goals, habits, and support needs before your wellness conversation.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
City / State
Instagram Handle
Preferred contact method
*
Text Message
Video Call (Zoom, FaceTime, etc.)
Phone Call
Email
In person (if local)
What are your wellness goals?
*
I want to lose weight overall
I want to gain weight/muscle
I want more energy
I just want to maintain a healthy lifestyle
Improve fitness/performance
Improve overall wellness
Other
How soon are you looking to get started?
ASAP
I need a trial first
Not sure/Just interested
What feels like your biggest challenge in getting results?
What would help you be most successful with coaching?
What other programs or approaches have you tried, and what results did you get?
How often do you eat out each week?
About how much do you usually spend per meal when eating out?
What is your budget for your goals?
*
Under $100
$100–$199
$200–$299
$300+
Open to recommendations
What wellness program are you interested in?
21-day challenge
1:1 coaching
Product support only
If yes, how long ago?
Less than a year ago
Over a year ago
I am currently using an Herbalife Nutrition product
N/A
Additional information for your future coach
Optional
Please verify that you are human
*
Have you ever used Herbalife Nutrition before?
Yes
No
Are you also interested in learning more about the Herbalife Business Opportunity?
I want to start the business opportunity right away
I am open to learning more
No, I am only interested in using products
Not now, maybe in the future
Submit
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