Wellness Evaluation

We Assist individuals in making good nutritious food choices to achieve their health and body goals.

Offer free wellness assessments,

One-on-one online coaching

Workouts,

Recommend healthy nutrition products, easy and healthy meal plans and snacks.

Guide and support your health and wellness journey.

First name

Last name

Date of Birth

Weight:

Height:

Gender:

Phone Number

Country of Residence

Have you been hospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness, or injury?

Yes

If you answered yes to any question, please elaborate

What is your Wellness Goal?

Gain Healthy Weight

Shape up or lose some weight

Start a Healthier Lifestyle

Build Muscle

Do you do/have any of the following? * Required

Skip Breakfast or Meals

Low energy and tiredness

Food Cravings

Exercising and not losing weight or shaping up

Realistically, how much would you invest to achieve this monthly

50-100

100-150

150-200

200+

Tell me a little bit about yourself

Please rate your readiness for change *

1-4

5-7

8-10

Have you used Herbalife Products in the past

Yes

Many years ago

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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