Wellness Profile

Wellness Profile Form

Hello! Congrats on your desire to take wellness into your own hands. We have been working in health & wellness for over 8 years now and am excited to take some time to review your goals with you.
Name*

First NameLast Name
Email*
example@example.com
How do you prefer I contact you?

Facebook MessengerInstagramTextingEmail
If you chose texting, please enter your phone number!
What is your name on Facebook & Instagram?*
Where is your energy level on a scale of 1 to 10? 1: being very low, 10: very high*

12345678910
How active are you?*

Very active (athlete)Moderately Active (exercising on a regular basis)Not active
How often do you workout?*
How do you sleep & about how many hours?*
Do you eat 3 meals a day?*

YesNoSometimes
If no or sometimes , which meals do you usually skip *
Do you know how much protein you eat each day?*

YesNo
What do you crave the most?*

SweetsSaltysFruits/SaladsFatty FoodsOther
How many glasses of water do you drink daily?*
Do you feel you have good nutrition?*

PoorNormalGood
How much do you spend on breakfast each day?*

$3-$4$5-$6$7-$8$10+
How much do you spend on lunch each day?*

$3-$4$5-$6$7-$8$10+
How much do you spend on dinner each day?*

$3-$4$5-$6$7-$8$10+
How much do you spend on snacks each day?*

$3-$4$5-$6$7-$8$10+
Are you using any nutritional supplementation *
Have you ever used Herbalife Nutrition products before?*
Tell me your health & wellness goals!*

WeightlossWeight GainClear SkinMore EnergyOverall WellnessDigestive IssuesLean Muscle GainHeart HealthOther
If other, please explain below!*
What have you done in the past that worked for you to achieve your goals?*
What have you done in the past that DID NOT work? Why do you think it didn't work?*
How serious are you about setting the goal, doing the work and achieving the results?*

I'm serious and ready, I'd like results in the next 30 daysI'm kinda serious, I'd like results in the next 60 daysI'd like to get started laterI'm Just Curious
Why now?*
Would you be interested in our next challenge?*

Yes!Not at this time
Are you interested in the products, the business opportunity, or both?*

The ProductsThe Business OpportunityBoth!The products and possibly the business opportunity in the future !
I really look forward to meeting with you. Do you have any final thoughts for me before we meet?*
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Wellness Profile Form