HI, I'm your Coach Admiral
I'm going to coach you and help transform your body to your body goals. I have been with Herbalife for 2 years and counting . Herbalife has helped Tone up and continues to help me assist people in achieving their body goals, you are welcome too!
Your FREE Wellness Evaluation
Based on the information given below, I will provide a detailed Wellness Evaluation / Meal Plan to help you achieve your current health/fitness goals. This wellness evaluation will act as a roadmap taking you from where you are today to where you want to go. As health coaches we know that in order to reach your goals, it takes 20% fitness, 80% nutrition and 100% mindset. If you're ready, let's begin!
Fields marked with a (*) must be filled in please
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Contact Number
*
When is a good time to contact you?
Morning
Afternoon
Evening
Whatsapp Number if different from contact number.
*
ex :+27711859453
E-mail
*
Real results for real people. Whether your goal is to * Lose weight * Gain weight * Shape up * Increase energy Then this is for you. See some of our many results from all over the world below
Gender
*
Male
Female
How are your energy levels during the day?
*
Terrible
Low
Average
Good
Amazing
Are you often bloated or have difficulty going to the toilet?
*
Yes
No
Do you often feel tired during the day?
*
Yes
No
What is your breakfast routine like? (tick all that apply)
*
Skip breakfast
I eat cereals or toast
I eat bacon and eggs
I have breakfast within an hour of waking up
I have a late breakfast at 10am or later
Other
Do you eat a variety of colourful fruits and veg?
*
Yes
No
Do you drink at least eight glasses of water per day
*
Yes
No
How often are you eating
Sweets
*
Never
Sometimes
Often
Daily
Baked goods (biscuits/pies/cakes)
*
Never
Sometimes
Often
Daily
Take aways
*
Never
Sometimes
Often
Daily
Fizzy drinks
*
Never
Sometimes
Often
Daily
Alcohol
*
Never
Sometimes
Often
Daily
How often do you EAT OUT a week (this includes take aways)
*
Hardly ever
1-2 times
3-4 times
How much do you spend on meals every day? This includes snacks, drinks and meals
*
R40-R60 per day
R70-R100 per day
R110-R150 per day
R160-R200
What are your health goals currently? (tick all that apply)
*
Weight loss
Weight Gain
Muscle Gain
Increase Energy
General Health
Sport Nutrition
Skin Nutrition
Hair Nutrition
Other
What is your why? Is there an event you are working towards? Or do you want to clean up your lifestyle? Be specific!
*
How serious are you about your health goals?
*
Not very
Sort of
Serious
Very serious
List any vitamins/supplements you currently take(N/A if none)
*
What kind of physical exercise do you do and how often (if any)
*
Do you suffer from any of the following health issues? (tick all that apply)
*
Acne
Constipation
Bloatedness
Muscle or joint pain
Fatigue
Migraines or headaches
Heartburn
Insomnia
PMS
Ulcers
Poor circulation
High blood pressure
Low blood pressure
Medical Conditions
*
Please Select
Yes
No
Do you have any medical conditions or injuries that Coach needs to be made aware of?
If yes, please specify:
Disclaimer:
It is advised that you consult your doctor before participating in any nutritional programme. All results are specific to the individual and are based on following the Herbalife Nutrition programme which is combined with healthy lifestyle.
Please list 3 friends or family who you think would benefit from doing this FREE WELLNESS EVALUATION
Please list Name and whatsapp number. Eg: Pamela McLean, 076 485 1251
Friend 1
Whatsapp Number
Friend 2
Whatsapp Number
Friend 3
Whatsapp Number
NOW THAT THE HARD WORK IS DONE
CLICK THE LINK BELOW TO SUBMIT
SUBMIT FREE EVALUATION
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