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Health Evaluation
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Completing the following survey will put you in touch with your Personal Wellness Coach. Your coach will then contact you to answer your questions, discuss your wellness goals and arrange a detailed personal consultation and recommendations.

We pride ourselves on providing a personal and efficient service. The more information you provide us with the quicker and more effectively we can deal with your request.

We look forward to working with you to achieve your health and wellness goals.

Please ensure that you complete the mandatory fields, marked with “ * ”

First Name *
Address 1
Surname *
Address 2
Email *
Address 3
Day Telephone
Evening Telephone
Best time to call *

Which of the following statements applies to you?

Have you tried any of the following weight loss programmes?
I would like to lose weight
I would like to gain weight
I would like to maintain my weight
I would like to feel healthier
I would like more energy
I would like to feel more confident
I would like to look better

Weight Watchers
Slimming World
Rosemary Conley's Hip & Thigh Diet
Atkins Programme
Other (please specify -->)
What is your weight loss/gain goal?
Why do you want to lose/gain weight?

When are you looking to lose/gain the weight by?
How much would you be prepared to spend per day to achieve your goal?


Where did you see our advert?

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"I wish to receive further information about related products"

I started on the Herbalife Weight Management Programme and Thermojetics Herbal Beverage, Herbal Complex and Fibrebond and started losing weight straight away.

Combined with a more active lifestyle I went on to lose 60 lbs* with Herbalife, and managed to reach 10st, I honestly thought I would never get there! I felt fantastic, I was so healthy and had so much energy.

Intelligent Core Nutrition
Healthy Breakfast
Weight Management
Weight Loss Programmes
Weight Loss Enhancers
Weight Loss Challenge
Healthy Snacking
Weight Gain
Weight Maintenance

Energy & Fitness
Energy Drinks
Protein Shakes
Protein Snacks
Sport Supplements

Targeted Nutrition
Healthy Men
Healthy Women
Digestive Health Healthy Heart
Healthy Ageing
Immune Health
Skin & Hair Care
Daily Skincare
Skin Revitalisers

Soothing Aloe
Make Money Helping

*All weight loss claims refer to the Herbalife Weight Management Programme which includes, amongst other things, a balanced diet, regular exercise, an adequate daily fluid intake and appropriate rest. The Herbalife products are not intended to diagnose, treat, cure or prevent any disease.

These materials were prepared by and are the responsibility of independent Herbalife distributors:
Buy Herbalife Online: Buy Herbalife Online - Weight Loss

Independent Herbalife Distributor: Customer Services,
, , ,
, customer.servicesxx@arribaxxsystems.co.uk