Wellness Kickstart Form
Hey Bestie! Congratulations 🎉 on choosing you. Before we dive into anything, I need to know about YOU. This quick form helps me tailor exactly what you need—so be honest + real, I got you
Name
First Name
Last Name
Email
example@example.com
How do you prefer I contact you?
Facebook Messenger
Instagram
Email
Texting
If you choose texting; please enter your number!
Ex: (555)555-5555
What is your Facebook name?
What is your Instagram name?
What is your TikTok name?
Where is your energy level on a scale of 1 to 10? 1: being very low, 10: very high
1
2
3
4
5
6
7
8
9
10
How active are you?
Very active (athletic)
Moderately Active (Exercising on a regular basis)
Not Active
Type option 4
How often do you workout?
How do you sleep and how many hours?
Do you eat 3 meals a day?
Yes
No
Sometimes
Type option 4
If no or sometimes , which meals do you usually skip
Do you know how much protein you eat each day?
Yes
No
Type option 3
Type option 4
What do you crave the most?
Sweets
Salty
Fruits/Salads
Fatty Foods
Other
How many glasses of water do you drink daily?
Do you feel you have good nutrition?
Poor
Normal
Good
How much do you spend on breakfast each day?
$3-$4
$5-$6
$7-$8
$10+
How much do you spend on lunch each day?
$3-$4
$5-$6
$7-$8
$10+
How much do you spend on dinner each day?
$3-$4
$5-$6
$7-$8
$10+
How much do you spend on snack each day?
$3-$4
$5-$6
$7-$8
$10+
Are you using any nutritional supplements?
Have you ever used Thrive by Le-Vel products before?
Please Select
Yes, I have a coach
No, never before
Yes, but I do not have a coach
Tell me your health & wellness goals!
Weightloss
Weight gain
Clear Skin
More Energy
Overall Wellness
Digestive Issues
Lean Muscle Mass
Heart Health
Other
If other, please explain below!
What have you done in the past that worked for you to achieve your goals?
What have you done in the past that DID NOT work? Why do you think it didn't work?
How serious are you about setting the goal, doing the work and achieving the results?
I’m serious and ready! I’d like results in the next 30 days
I’m kind of serious, but I’d like results in the next 60 days
I’d like to get started later
I’m just curious
Why now?
Would you be interested in a 10-day detox?
Yes
Not at this time
Are you taking vitamins; if so, what kind ?
Thrive by lE-veL
None!
Other
I really look forward to meeting with you. Do you have any final thoughts for me before we meet?
*
Submit
Should be Empty: