Wellness Evaluation

Wellness Evaluation

Habits - Nutrition - Mindset - Exercise - Community Support
Name

First NameLast Name
Email
example@example.com
Whatsapp number

Area CodePhone Number
Gender
How did you hear about us?
Please provide a name of the person who sent you the link
What do you have for breakfast?
Please write food and drink or N/A
What do you normally have for mid morning snack?
Please write food and drink or N/A
What do you usually have for lunch?
Please write food and drink or N/A
What do you normally have for afternoon snack?
Please write food and drink or N/A
What do you generally have for dinner?
Please write food and drink or N/A
Do you snack in the evenings, food /drink?
Please give an example what you snack on in the evenings
How many coffees/energy drinks drinks do you have per day?
How much water do you drink daily on average?
How many times did you exercise in the past 7 days?
How many hours of sleep do you get on average per night?
Please type the number of hours you sleep per night
How are your energy levels, on a scale from 0-10?
Please write a number, 0 worst, 10 best
What is your physical state at the moment, on a scale from 0-10?
Please write a number, 0 worst, 10 best
Do you know how much protein you consume in a day? Do you know how much your body needs daily?
What are your main lifestyle CHALLENGES? (choose as many as you like)

Other
What are your goals

Other
Please add any other health /body/life goals you have:
Please share with me why it's important for you to reach your goal?
How ready are you to improve your energy, health & fitness levels, on s scale from 0-10?
0 not ready, 10 ready to start
Do you have a Coach that´s supporting you?
Yes / No / in what way
Why LEVEL 10 CLUB?
1. Personal Wellness Coach
2. Partnership with Herbalife nutrition - Simple & Effective Solutions
3. Positive Online Environment for Participants, Step by Step
4. Habits Improved at Home & On the Go!
5. Loyalty & Reward Plan, Pricing Privilegeds, Free Products, Income Possibilities.
Your next step, choose 1 -2 - 3 or 4:
Please choose one option
Your Next Step:
Have you used Herbalife Nutrition before?
What is your budget for your Wellness Program
Are you interested in:
Bonus Question: We are looking for Level 10 Assistant Coaches! People (at all ages) who have Passion for Health & Wellness, their own and would like to support others in getting healthier. We work from home or in clubs, 7-10h/week. Would you like to know more about it and the rewards that come with it?
Extra Bonus Question: Would you like to offer this evaluation to a friend(s)? Please pop their name/number below & forward them my link. - More names will increase your chances of winning my lucky draw :)
Please type name& numbers of your friends that you will forward the link to, thanks.
I´m looking forward to supporting you on your journey towards your goals!
Should be Empty: