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10 Day Express weight loss Challenge - Wellness Profile!
Who referred you to this Marathon?*
Name
Full Name*
First Name Surname
Gender*
Male Female
Email*
example@example.com
Which Town and Province do you live in?*
What is your biggest challenge in losing weight? (e.g eating healthy snacks)*
Whatsapp Phone Number*
(082 ect) Phone Number
Age*
years
Height*
cm
Weight*
KG
Have you ever used Herbalife Nutrition products before?*
Yes No
If YES, how long ago?
Whats the activity level at your job?*
None (seated all day) Moderate (light activity such as walking) High (heavy labor, very active)
How many Kgs would you like to lose?*
Do you eat 3 meals a day?*
Yes No
If no, which meals do you skip?
Breakfast Lunch Dinner
Do you generally snack?*
Yes No
How many days a week do you eat out?*
1-3 3-5 over 5 never
How much water do you drink daily?*
1 glass 2-3 glasses 1 to 2 Litres 3 Litres What's water?
Please rate your commitment to achievement of your goal?*
1 2 3 4 5 6 7 8 9 10
Why?*
Should be Empty: