Health Evaluation Survey, Results on Health, Nutrition, Food and Supplements

What is your body type?Thank you in advance for filling in the health evaluation survey. Don't worry the results information is Only posted on the follow up page and is not used for any other purpose. The form only shows a trend comparing your results with all those who have filled in the form. For your participation you will receive our free report Herbalife Success Guide.

Health Evaluation Survey

Please note that all fields followed by an asterisk must be filled in.
First Name*
Web Site URL
E-mail Address*
Height Ft.-in (i.e.) 5-7
What is your Weight in pounds?
Which best describes your health?
Do you use any nutritional supplements? (vitamins, nutritional shakes, supplements)
Herbal Alternatives
Supplements that you use
Are you taking any medications?
Herbal Alternatives
How would you describe your lifestyle?
Do you participate in sports?
Do you exercise regularly?
Do you suffer from any of these symptoms?
How many meals do you eat per day?
How much do you spend per day on breakfast?
How much do you spend per day on Lunch?
How much do you spend per day on mid-afternoon snack?
How much do you spend per day on dinner?
How much do you spend per day on mid-night snack?
How much do you spend per day on evening snack?
How much do you spend per day on food?
How much do you spend per day on beverages?
How many times do you eat out per month
What is the best way to lose weight?
Would you like to lose weight?
Gain Weight
At ideal weight
Lose weight
How much weight would you like to lose, in pounds?
What diets have you tried in the past

Please enter the word that you see below.


Free reportThank you for your participation. The results are shown on the next page. Click the "Submit" button to see your results and get your free report, "Herbalife Success Guide."

See Also:
Weight Loss Tips 10 sensible weight loss tips that burn fat.
Sample Pack is also available as part of our ShapeWorks weight loss programs
Successful Weight Loss - Planning tips.
Herbal Enhancers
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