Wellness/Fitness Evaluation Form
Are you ready to achieve your wellness/fitness goals? This is definitely where you need to be!
Tell me about yourself!
Name
First Name
Last Name
What are your current fitness goals? (select all that apply)
Lose Weight
Gain Weight
Live healthier and eat better
Gain more energy
What is your gender?
Male
Female
Nonbinary
What is your Instagram profile name?
Phone Number*
About how much do you exercise on a weekly basis?
Little or no exercise
1-3 times a week
4-5 times a week
Daily
Have you ever tried Herbalife?
Yes
No
Are you ready to achieve your goals??
Let's do it!
Not yet.
Email Address
Submit
Should be Empty: