HEATH & WELLNESS PROFILE

LETS LIVE A HEALTHY & ACTIVE LIFE

Hi Kings and Queens, please fill up this wellness evaluation as it will allow me to understand what you’ve been struggling with. Only after going thru it I’ll get to have a clearer vision of the new habits we are going to work on to help you achieve your goals. Please be 100% honest, this is a judgment free zone. On your mark, Get set, Goo!!!!
1) PERSONAL INFORMATION
Name

First nameLast name
Phone number
Please add your area codeFormat: (000) 000-0000.
Address

Numéro et rue

Complément d'adresse

CityÉtat/Région

Code PostalCountry
Current weight
exemple : 50 kg / if you do not know put an estimation
Height
exemple : 1m50
Age
exemple : 18
Instagram Username
If you dont have instagram write NO
Email
Example : daiisyfit@outlook.fr
2) YOUR GOALS
My goal is (check all that apply)
How many kg / lbs would you like to LOSE ?
Answer only if you are looking to be on a weight loss program
How many kg / lbs would you like to GAIN ?
Answer only if you are looking to be on a weight gain program
3) YOUR NUTRITION
Do you eat 3 meals a day ? If no, which meals do you tend to skip ?
What do you have for breakfast ?
Do you snack ? If yes, what time of the day ?
What do you snack on ?
Daily water intake
What else ?
Do you consume alcohol regularly
How many times a week do you eat out ?
Average cost per meal ?
What is your energy level on a scale of 1 to 10 ?
Are you currently taking supplements ? If yes, which ones ?
4) ACTIVE LIFESTYLE
How often do you exercise in a week ?
Are you interested in a
5) OTHER INFORMATION
Are you Vegan ?
exemple : yes / no
Do you consume dairy ?
exemple : yes / no
Do you struggle with bloating or water retention ?
Are you pregnant or Breastfeeding ?
exemple : yes, pregnant
Have you ever taken Herbalife before ?
If yes, how long ago ?
Are you interested in hearing how to earn an extra income with Herbalife?
I am excited to help you achieve your goals and would love to help those you love do the same. I extend the offer for a FREE wellness evaluation to 5 of your friends.
Please enter their names, Instagram & phone number below :
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LETS LIVE A HEALTHY & ACTIVE LIFE