*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
What are your primary fitness goals? (Choose all that apply)
*
Weight Loss
Muscle Gain
Increase Endurance
Improve Overall Health
Improve Mental Well-being
Other (please specify)
Do you have any medical conditions or injuries that may impact your ability to exercise? (joint pain, high blood pressure, etc.)?
*
Are you currently taking any medications that may interact with exercise?
How important is it for you to see results within the next 3-6 months?
*
Very important
Somewhat important
Not very important
Not at all important
What type of exercise do you enjoy most? (Choose one or more)
*
Cardio (running, cycling, swimming, etc.)
Strength training (weightlifting, bodyweight exercises, etc.)
High-intensity interval training (HIIT)
Yoga/Pilates
Group fitness classes (Zumba, spinning, etc.)
Other
How many days per week can you realistically commit to exercising?
*
1-2 days
3-4 days
5-6 days
Every day
How would you describe your current physical activity level?
*
Sedentary (little or no exercise)
Lightly active (light exercise/sports 1-3 days/week)
Moderately active (moderate exercise/sports 3-5 days/week)
Very active (hard exercise/sports 6-7 days a week)
Extremely active (very hard exercise/sports & physical job or 2x training)
Other
How soon would you like to start?
*
Immediately
In the next few weeks
Not sure
Other
Have you tried the Herbalife supplements?
*
Yes, I'm a member/Distributor
Yes, in the past
No, but I'm interested in hearing about it
Submit
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