Wellness Evaluation Form
Hiii πβ¨ Iβm π¨πͺπ₯ππ§ excited to help you get started on the π π π π nutrition in the world and to also inspire you to become YOUR best self π¦ Remember β in order for things to change, πππ have to change! If I can do it , so can you. The only thing that I regret is not starting this lifestyle wayyy sooner. It feels π¦π’ good to work on yourself in every aspect β physically , mentally , emotionally , spiritually β and soon youβll be indulging in those same feelings too! Anything is possible β believe that you can and you will. You have πππππππ to lose and EΜ³VΜ³EΜ³RΜ³YΜ³TΜ³HΜ³IΜ³NΜ³GΜ³ to gain! Progress *πΈπππΈππ* involves risks. Thereβs so much more that you can accomplish once you start to feel good about yourself and truly work on π΄ πͺ π° . You got thissss boss babes , now letβs reach our goals TOGETHER! π
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth (MM/DD/YYYY)
Email
example@example.com
Residence
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Instagram AND Twitter (if applicable)
Have you ever been an Herbalife Preferred Member?
Yes
No
Whatβre your goals? (Check all that apply)
I want to lose weight
I want to tone up / build muscle
I want to gain weight
I want to feel more energized
I want to lose baby weight
I want to live a healthier lifestyle and change my eating habits
Other
How serious are you about achieving your goals?
Very serious!
Not so serious yet, but Iβm getting there
How soon are you looking to start?
Now
RIGHT NOW .. Iβm ready as soon as Iβm done filling out this form !
Are you interested in the business opportunity?
Yes
No
Maybe later
Approximately how much do you spend on your meals daily?
π₯ to a BETTER ME! β¨
Should be Empty: