Wellness Profile.

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Wellness Profile.

Welcome and congratulations for taking the first step into a healthier, happier lifestyle.

PLEASE FILL OUT PROFILE HONESTLY AND AS ACCURATE AS POSSIBLE TO RECEIVE BEST ASSISTANCE.

Email *

Do you have any allergies or health concerns?😷 *

Have you ever used HERBALIFE NUTRITION before? 🏪 *

Yes

Complete Full Name *

Phone Number 📲 *

Instagram name *

Facebook Name *

When is the best time to reach you? *

Mornings 9:00am to 12:00pm

Afternoon 1:00pm to 4:00pm

Evenings 5:00pm to 8:00pm

Other:

Where are you located? 🌏(country/ state/ city) *

Age/height/current weight? 📝 *

Who did you receive your wellness evaluation from? *

Trennise

Jaron

I would like to accomplish: select the answer/ answers that best applies to your current health goals. *

I’d like to eat better and have a healthier lifestyle

I want to lose weight 5 -15 lbs (tone)

I want to lose 15 - 30 LBS

I want to lose 30+

I want to tone my stomach

I want to gain lean muscle

I’m an athlete and want to enhance my performance and recovery

Other:

Required

How committed are you to fully achieving your health goals? *

I'm just looking for a quick way to get results then I'm done.

I'm open to using the product but not so much the coaching.

I want to achieve a whole lifestyle change and live a healthier life.

Other:

How many meals do you skip daily *

I skip the majority of my meals

I skip two meals

I skip one meal

I don’t skip any meals

How many times a day do you snack daily? *

Mostly all day

In between meals

Once a day

I don’t snack at all

How much water do you drink a day? Choose the best that applies. *

1 cup

A bottle of water

Two bottles of water

A half of a gallon

A whole gallon

Do you drink any other liquids? Please choose all that applies. *

Coffee

Tea

Energy Drinks

Juice

Soda

Alcohol

Required

What is your fitness level? *

Walking Only

I Jog often

I do cardio

I do HIT cardio

I lift

I’m not a fan of exercise

How much do you spend on food, drinks, snacks per day?💳 *

$5-10

$10-20

$25+

I prep all my meals and snacks

Do you have any friends and/ or family that would benefit from a healthier and more active lifestyle? *

I know 1 person

I know 2 - 3 people

I know 3 - 5 people

Are you interested in learning how to earn extra Income from home and how you can get your nutrition plan at a discount💲💲💲? *

Yes I'm interested!!!

Thank you but not right now!

Congratulations for choosing to change a few habits to enhance your quality of life!! We're excited to assist you onto achieving your best result yet!!! Please contact the sender of wellness profile via text or social media to inform them that you’ve completed your survey. *

Thank you for completing the form!!!!

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms