get fit

1

Full Name* This field is required.

First Name

Last Name

2

Gender* This field is required.

Male

Female

3

Phone Number* This field is required.

Area Code

Phone Number

4

Email* This field is required.

example@example.com

Confirm Email

5

Instagram name* This field is required.

8

What are the top three goals you want to accomplish, in order of importance?* This field is required.

9

Explain why these three goals are most important to you.* This field is required.

10

What possible personal barriers do you feel are keeping you from reaching your nutritional and fitness goals?* This field is required.

Lack of motivation

Time

Self Conscious

Lack of equipment

Lack of Results

Hitting A Plateau

Money

Not knowing where/how to begin

Other

11

Please rate your motivational level to do what it takes to reach your goal.* This field is required.

1
2
3
4
5
6
7
8
9
10

I have no motivation to change my life.

I'm ready to make any lifestyle changes to reach my goals!

12

What motivates you?

Need a strong motivator to push you to exercise

You like to be informed about your program and how it is going to lead you to your goals

Like to try new things if they are effective

Willing to push past your comfort level to reach your goals

If I feel things are really hard I tend to back off

Need to be held accountable for what I am doing

Being sore the day after a workout tells me my workouts are working

Other

13

How much do you spend on average daily for breakfast?

14

Have you tried Herbalife? * This field is required.

15

How soon are you looking to get started?* This field is required.

Right away

Have some things to take care of

Type option 4