Health and Lifestyle Survey

Herbalife Independent Distributor

Health and Lifestyle Survey

Have you ever wondered how your current health and lifestyle impact your future well-being? If you answered yes to this question, then it's time to take the Herbalife Health and lifestyle Survey. Can you spare me just two minutes? I am doing a survey on important health and lifestyle issues.

Full name
Address
Occupation
Address(work)
Zip Code
Telephone(home)
Telephone(work)
Which of these words best describes your own lifestyle?
Do you think you get 100% of the daily nutrition needed for good health?
Do you take nutritional supplements (vitamins/minerals/proteins)?
Do you experience a loss of energy during the day?
Do you, or does any member of your family or friends need to lose, gain or maintain weight?
Approximately how much weight do you/ they need to lose?
Have you tried diet programs in the past?
Which diet programs have you tried?
Do you eat a variety of healthy foods from the basic food groups every day?
If no, why not?
Are you interested in learning about a nutritional program to control weight while still eating the foods you like, without feeling hungry?
Would you prefer futher information to be sent to your home or office?