Hi I am your health coach Michelle

Hi I am your health coach Michelle

I help busy women lose belly fat without time-consuming restrictive diets and work with you to improve key areas of your health.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
When is a good time to call you?
Gender
What is / are you health goals?
Do you lose energy during the day?
How are your energy levels during the day?
Do you have prediabetic symptoms
Do you suffer from bloating or have difficulty going to the toilet?
What is your breakfast routine? Tick all that apply

Other
Do you eat a variety of colorful fruits and vegetables?
Do you drink at least 8 glasses of water a day?
Do you eat sweets?
How often do you eat baked goods (biscuits, pies, cakes)?
How often do you eat takeaways
Fizzy drinks
How often do you eat out per week (including take-aways)?
How much do you spend on meals every day (including snacks, drinks and meals)?
What are your health goals? Tick all that apply
How serious are you about your health goals?
List any vitamins or supplements you take
What type of physical exercise do you do and how often?
Do you suffer from any of the following health issues. Tick all that apply
What is your why? Is there an event that you are working towards or do you want to life a healthier lifestyle? Be specific.
Do you have any medical conditions?
If yes please specify
Disclaimer : -It is advised that you consult your doctor before participating in any nutritional programme. All results are specific to the individual and are based on following the Herbalife nutritional programme which is combined with a healthy lifestyle.
Please list three friends or family who you think would benefit from doing this FREE HEALTH EVALUATION

Please list their name and number
Friend 1
Number
Friend 2
Number
Friend 3
Number
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