Wellness evaluation
Congratulations! You have taken one of the most important steps to obtain excellent results.
Name
Nombre/First Name
Apellido/Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Age:
Height:
Peso actual / Current weight:
Desire weight:
What is your goal?
*
Weight loss
Increase muscle mass
Detox
7 day program
14 day program
21 day program
60 day program
Extra income
Other
Any medical conditions? (Ex. Alergies?)
*
What's your percentage?
0% - 20%
20% - 30%
30% - 40%
40% - "+"
If you are a mother, Are you a nursing?
Yes
No
N/A
How's your work area?
Sedentary
Active
I do not work
How many times a week would you be able to workout?
1-3
3-5
As necessary
Where would you be training?
Home
Gym
Varies
Do you do all of your meals?
No
Yes
Sometimes
Meal examples:
Example of your meals:
Breakfast:
Lunch:
Dinner:
Snacks:
Energy level?
1-10
Stress level?
1-10
How much are you looking to spend on your program?
*
$0 - $100
$100 - $200
$200 - $300
As necessary
How did you know about me?
*
Facebook
Instagram
Other
Have you used Herbalife products previously?
*
Please Select
Si/Yes
No
If Yes, we're you a preferred member (VIP)?
Submit
Should be Empty: