Wellness Profile

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

What is your health goal?* This field is required.

Lose Weight

Tone Up

Build Muscle

Post Partum Journey

Maintain a Healthy Lifestyle

5

Have you tried Herbalife before?* This field is required.

YES!

Yes, 3-6 Months Ago

Yes, 7-12 Months Ago

Yes, but it’s been a few years

No.

6

How many meals do you eat in a day? Do you ever skip meals?* This field is required.

7

Do you snack? If yes, what do you snack on?* This field is required.

8

How many times during the week do you eat out?* This field is required.

9

How much water do you drink daily? What else do you typically drink in a day?* This field is required.

10

Is there a day and/or time during the week that works best for you to complete your wellness profile?* This field is required.

11

When are you most tired?* This field is required.

12

When are you most hungry?* This field is required.

13

You will have the option to join our 3-Day Challenge at our meeting. Is this something you would like to do?* This field is required.This is a great way to try our products for three days at a low cost.

Absolutely! Sign me up!

I would like to hear more about it!