Name
First Name
Last Name
Age
Height
Weight
What is your goal? (Weight loss/weight gain/health)
Why is it important for you to reach this goal?
*
What do you feel stops you from achieving your goal?
*
What are your goals?
Reduce Body Fat - Lean&Fit Program
Gain muscle - Building program
Improve overall health - accountability program
Weight loss programOmg
Besides the gym how would you describe your daily activities?Please answer accordingly!
Sedentary - you spend a lot of time sitting at a desk (bank teller, desk job, graphic designer, customer service)
Light Activity - Spend a good part of the day on your feet (teacher, salesman, barber)
Moderate - Spend a good part of the day doing physicalactivity (waitress, mailman)
Very Active - Spend most of the day doing heavy physicalactivity (mall man, carpenter, construction worker, warehouse jobs, full time dancer)
Days per week exercising?
4 or less
5 most of the time
6 or more
What foods are you currently eating throughout the day? ( give us an example of what you had yesterday )*
Will you be training at home or a gym facility?
*
Home
Gym
I will not be training, i just want a nutrition plan
Have you tried Herbalife products before?
First time!
Years ago
Type option 3
Currently taking my products
If yes, reach out to your coach!
If no contact with coach, continue with survey!
When would you like to start?
*
I’m ready today
This upcoming Monday
Next week
How much are you willing to invest in you?
*
$150 +
$200 I’m ready
$250-$300 Im all in my
Give me all I need
Instagram user name
Email
Phone Number
-
Area Code
Phone Number
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