Wellness Evaluation

Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Area CodePhone Number

Birthday *

For breakdown on goals but also celebrations

1. What is your goal?*

Ex: Weight-loss, Muscle Gain, Detox, Energy Etc

2. What is your current weight and height?*

If you haven’t weighed in the last 30 days. Re-weigh or estimate.

3. How often do you work out in a week?*

Exercising consecutively for 30 minutes. Walking is a form of exercise.

4. What do you eat for breakfast and what time? *

What is the most consistent thing you'll eat for breakfast.

5. Do you skip any meals or snacks? If so which ones.*

7. Are you taking any supplements including vitamins, If so why?*

Even prescribed by doctors

6. What have you tried before and why did you stop? *

Herbalife or any other products

8. What is your main motivation for this goal? *

Take time to think about this. Is there a deadline to meet, an event, or deeper rooted

9. What is a reason why you haven’t reached your goal? *

What has held you back? What have you allowed to be a distraction or limit your efforts.

10. Are you ready to start today? *

If not ready. When will you be ready?

11. What are ways you would like to be recognized for your hard work?*

Ex: Customized gifts, Cash Back, Retreats, Products

12. What is your next available day and times to review and customize plans?*

Zoom call will be about 40-60 min.

13. Coaching requires both of us to be honest, stick to the plan, and be willing to communicate in the good days and not so good days. What are some expectations you want/ need from your coach? *

All answers are good answers. Help me be the best for you to have better.

Information Request