WELLNESS PROFILE QUESTIONNAIRE
*Please answer each question down below*
Client Information :
Full Name
*
First Name
Last Name
Age
*
Email
*
example@example.com
Instagram or Facebook handle (if you have one)
*
Wellness Goals :
What are your main health goals? (Fat loss, muscle gain, better energy, better sleep, improved digestion, etc.)
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How much time are you willing to commit to achieve your goals?
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What areas do you need the most support with?
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Nutrition
Workouts
Mindset
All of the Above
Current Diet :
What does a typical day of eating look like for you? (BE HONEST!)
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What’s been holding you back from reaching your goals until now?
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Have you ever followed a structured nutrition or workout program?
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Yes
No
Are you currently taking any medications? (If yes, please list them.)
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Are you currently taking any supplements? (If yes, please list them.)
*
Do you have any known allergies or sensitivities?
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How often do you currently work out?
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Where do you usually train?
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Gym
Home
Outside
I don’t train
How many caffeinated beverages (coffee, tea, energy drinks) do you consume per day?
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Do you have any dietary restrictions or preferences? (Vegan, vegetarian, no dairy, etc.)
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How many meals per day do you eat on average?
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What types of snacks do you usually go for? (Chips, fruit, protein bars, sweets, etc.)
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Where do you tend to gain weight or store fat the most? (Belly, hips, legs, arms, etc.)
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Have you ever used Herbalife before? If yes, when was the last time?
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What’s your current monthly wellness budget?
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Under $100
$100-$150
$150-$200
$200-$250
$250+
Would you like to learn more about becoming an Herbalife Distributor?
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Yes
No
Would you be interested in doing our 15 Day Challenge?
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Yes
No
Is there anything else you’d like me to know?
*
Submit
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