Personal Training Consultation Questionnaire

Full Name /Nombre

First NameLast Name

Email

example@example.com

Phone Number/Numero telefónico

Area CodePhone Number

Date of Birth/Fecha de Nacimiento

Month/MesDay/DiaYear/Año

Height/Altura

cm/inch

Weight/Peso

KG/LB

have you try Herbalife Before / Has probado Herbalife antes ?

Have you ever done a digestive cleanse/ alguna ves te has hecho una limpieza digestiva?

If not would you like to know more about it/ si no tegustaria saber mas al respecto?

Have you ever been on a any management weight program/ alguna vez has estado en un programa de control de peso?

If not would you like to know more abou it / si no te gustara saber mas al respecto?

What following goals does best fit in with your goals/ que objetivo de los siguientes se ajusta mejor a tus objetivos?

TImeline for achieving your goal/ cual es tu linea de tiempo para logras tu meta?

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

I am so exited to be able to be part of your transformation thanks for your inquire

estoy moy emociona de tener la opetunidad de ser parte de tu tranformacion; gracias por estar interesada(o)

ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.