Health & Lifestyle Questionnaire

Health & Lifestyle Questionnaire

Please fill in the questionnaire below
Do you feel that you receive balanced nutrition from the foods you eat?

YesNo
How would you describe your energy levels?

AmazingOkUp & DownTerrible
Would you like to:

Gain weightMaintain WeightLose your bellyBe nice & lean or get ripped
How much would you like to lose/gain?

0-5kgs5-10kgs10-15kgs15-20kgs20kgs+
Do you exercise?

Not at allOccasionallyRegularly
Do you have any health concerns?

Diabetes Type 2Heart DiseaseStrokeObesityNoneOther
I work with Herbalife International and help people with their nutrition. I personally have had great results myself: - I Used to: - crave for sweets whole day - Never exercised - No energy - start weight 93kgs Now: - Don't crave food - Way too much energy throughout the day - Weight train x5 days a week and cardio twice a week - Happy to annouce I am 20kgs lighter already
A) For 3000/- can I offer you ?

10 Day Healthy meal products + Meal plan + workout planNo
B) Can I call you with more information about the Challenge?

YesNo
Name

First NameLast Name
E-mail
Insta Profile
example: www.instagram.com/nutrifitbrinda
Phone/WhatsApp

Area CodePhone Number
Should be Empty: