Health and wellness evaluation
Please answer the following questions
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Have you ever used Herbalife or spoken to a distributor before?
Where did you hear about me?
What is your Insta/FB name?
How long have you been following me on social media?
Have you ever been a Herbalife member?
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Wellness eval time
Do you eat breakfast?
Do you often skip breakfast?
How many meals do you eat per day?
What's a typical day of eating look like for you?
Do you have a goal in mind?
From 1-10, with 1 being the least, how serious are you about achieving your goal?
How old are you?
What is your height?
What is your weight?
What are the main reasons you're seeking wellness advice?
Do you exercise, and if so how often?
How do you rate your current level of health out of 10?
How do you rate your current energy level out of 10?
Do you get tired throughout the day?
How much water do you drink a day?
Do you smoke/drink alcohol? How often?
Do you have trouble getting to sleep?
How many hours of sleep do you get on average a night?
Do you have any known allergies?
What are you hoping to achieve from my programme? Do you have any additional information you think would be handy to share?
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