Herbalife- Wellness Partner Journey/ EG

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
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Gender* This field is required.
Male
Female
6
Date of Birth* This field is required.
Date
Year
Month
Day
7
Height* This field is required.
cm
8
Weight * This field is required.
Kg
9
What do you do for a living?* This field is required.
10
What has been your biggest challenge in achieving your body goals in the past?* This field is required.
Finding time for regular exercise
Staying consistent with a diet plan
Lack of motivation or accountability
Managing stress and emotional eating
Finding the right exercise or nutrition plan that works for me
Not seeing results quickly enough
Dealing with injuries or physical limitations
11
On a scale of 1-10, how confident are you in your current fitness and nutrition plan?* This field is required.
1-3: I’m not confident at all; I feel lost or unsure.
4-6: Somewhat confident, but I’m not seeing the results I want.
7-8: Fairly confident, but I think I could do better with guidance.
9-10: Very confident; I feel like I’m on the right track.
12
What are the top 3 obstacles you face in maintaining a consistent exercise routine?* This field is required.
Lack of time due to work, family, or other commitments
Low energy or motivation
Uncertainty about what exercises to do
Inconsistent sleep patterns or fatigue
Physical pain or discomfort
Boredom or lack of enjoyment in exercise
Financial constraints for gym membership or equipment
13
How do you currently manage stress, and how does it affect your eating or exercise habits?* This field is required.
Exercise regularly to manage stress
Meditate or practice mindfulness
Rely on food or snacking to cope with stress
Engage in hobbies or social activities to unwind
I don’t have a consistent stress management routine
Stress doesn’t affect my eating or exercise habits much
14
What motivates you to achieve your body goals (e.g., health, appearance, performance)?* This field is required.
To improve my overall health and well-being
To feel more confident in my appearance
To have more energy and vitality
To enhance my athletic performance
To reduce stress and improve mental clarity
To set a positive example for my family or children
15
Have you followed any diet or fitness program in the past?* This field is required.
Yes, I followed a diet plan but didn’t see the results I wanted
Yes, I followed a fitness program but struggled with consistency
Yes, I had success with a previous plan but couldn’t maintain it long-term
Yes, I tried multiple programs but found them too restrictive or hard to follow
No, I’ve never followed a structured diet or fitness program
No, I’ve always managed my own plan, but I’m looking for more structure now
16
How much time are you willing to dedicate daily/weekly to your fitness and nutrition regimen?* This field is required.
Less than 30 minutes a day
30-60 minutes a day
1-2 hours a day
3-5 hours a week
5-7 hours a week
More than 7 hours a week
17
What would you consider a successful outcome from working with me?* This field is required.
Losing a specific amount of weight
Gaining muscle and strength
Feeling more confident and comfortable in my body
Establishing a sustainable and healthy routine
Improving my energy levels and reducing stress
Overcoming specific physical or dietary challenges
Achieving a balanced and healthy lifestyle
18
Do you feel like you have good work-life balance?* This field is required.
Yes
No
19
Whats the activity level at your job?* This field is required.
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
20
How often do you include protein sources like meat, fish, eggs, or beans in your meals?* This field is required.
Rarely
Sometimes
Most Days
Every Day
21
Do you track your calorie intake or macronutrient ratios?* This field is required.
YESNO
22
Do you take any supplements or vitamins?* This field is required.
YESNO
23
How many hours of sleep do you typically get per night?* This field is required.
Less Than 6
6-7
7-8
8 or more
24
Do you usually feel well-rested when you wake up?* This field is required.
Rarely
Sometimes
Most Days
Every Day
25
Do you have difficulty falling asleep or staying asleep?* This field is required.
Often
Sometimes
Rarely
Never
26
Your current diet could be best characterized as:* This field is required.
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
27
Are you experiencing any stresses or motivational problems?* This field is required.
YESNO
28
At what times during the day would you prefer to train?* This field is required.
Morning
Mid-Day
Afternoon
Evening
29
Timeline for achieving your goal.* This field is required.
8 Weeks
16 Weeks
24 Weeks
32 Weeks
40 Weeks
1 Year
30
Please rate your motivational level to do what it takes for reach your goal.* This field is required.
1
2
3
4
5
6
7
8
9
10
31
Select the date to start your program.* This field is required.
Date
Year
Month
Day
Should be Empty: