Wellness Questionnaire

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Hi, I''m Candice and I help women to achieve body confidence and feel amazing!

Whether you'd like to:

- shape up/lose weight

- improve your energy levels

- experience better digestive health

- build a stronger immune system

- learn how to be healthier 

Our 10 Day Results Challenge is for you and can help you achieve your goals step by step! 

Fill in the form below so I can know a little bit more about you and I will contact you asap to chat about your goals and how I can help you xx 

(The answers to this questionnaire are completely confidential and will not be disclosed to anybody else.)

Name *

WhatsApp no/Phone no *

What are your health/ body goals? *

What do you usually have for breakfast? *

How would you rate your energy levels currently? *

I'm exhausted - I battle to wake up and feel like I need a nap daily

My energy levels are avergae

My energy is fine

How would you rate your eating currently? *

Terribly unhealthy

Average - some good days, some bad

I eat well but still struggle to achieve my goals

Do you struggle with cravings? *

Yes

How much water do you drink daily? *

Under 1L

1L-2L

2L-3L

Rate your body confidence *

Low

Its okay but could be better

Great!

Do you struggle with any of these digestive issues? *

No, my digestion is fine

I'm bloated

I get tummy cramps

I suffer from constipation

I have to avoid certain foods

I suffer from an upset tummy

Are you currently using the Herbalife Nutrition products? *

Yes I am currently using them and have a coach supporting me

No I have never tried them before

I tried them long ago

Thank you for filling out the questionnaire! I will be in touch with you shortly! *

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