WELCOME!
My name is Leslie and I am an Herbalife Wellness Coach. I am 40 years old and a mom of 4 beautiful kids. I’ve lost 48+ lbs on my postpartum journey and I am currently on my toning up/ Lean muscle gain Journey💪🏻
JOIN MY TEAM & AND LET’S BE FIT TOGETHER!
Whatever made you click this form I believe is no coincidence. Maybe it was a little voice or gut feeling pushing that made you click or maybe you’re just READY to get in the best shape of your life. Whatever it was FOLLOW that INSTINCT and let me help you!
Wellness Questionnaire
Thank you for taking your time to click on my link. By filling out this form, I will obtain some important information about you that can help get you started on your journey!
Full name
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First Name
Last Name
Phone Number
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Area Code
Phone Number
Email
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example@example.com
Location (Country)
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
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Iran
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Israel
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Jamaica
Japan
Jersey
Jordan
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North Korea
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Laos
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Liberia
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Marshall Islands
Martinique
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Mauritius
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Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
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Turkish Republic of Northern Cyprus
Northern Mariana
Norway
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Pakistan
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Panama
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Peru
Philippines
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Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
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Saint Lucia
Saint Martin
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Samoa
San Marino
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Senegal
Serbia
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Singapore
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Solomon Islands
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South Africa
South Ossetia
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Sri Lanka
Sudan
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
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Turkey
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Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Check All That Apply
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I want to LOSE WEIGHT
I want to GAIN WEIGHT
I want to GAIN MUSCLE
I'm pregnant and interested in a healthy pregnancy.
I'm a breastfeeding mom & want to get rid of my baby weight.
I want more information on the business.
How much do you spend on food per week?
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Have you ever tried Herbalife before?
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Yes
No
If yes, how long ago?
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Have you ever been an Herbalife member or a Distributor?
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Yes
No
If yes, how long ago?
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Are you interested in the business?
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Yes
No
Any message for your future Coach?
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