INDEPENDENT DISTRIBUTOR HERBALIFE: MARIA BOUSSOULEGA, MOB.: +30 6974 463131, e-mail:info@healthyandeasy.com
 
FREE CONSULTATION SURVEY
Your Personal Wellness Coach:
MARIA BOUSSOULEGA,
MOB.: +30 6974 463131
Independent Herbalife Distributor
Completing the following survey will put you in touch with your Personal Wellness Coach. Then he will contact with you to answer in your questions, discuss your Wellness goals and arrange your FREE Wellness Evaluation.
The more information you provide him with the quicker and more effectively he can deal with you your request.
I look forward to working with you to achieve your health and wellness goals.
 
 WHICH OF THE FOLLOWING STATEMENTS APPLIES TO YOU?
  I would like to lose weight
  I would like to gain weight
  I would like to maintain my weight
  I would like to increase body mass
  I would like to support my well being
  I would like to promote long-term good health
  I would like more energy every day
  I would like to minimize the appearance of fine lines and wrinkles
  I would like to rejuvenate my dull, tired-looking skin
  I would like to help pores appear smaller and less noticeable
  I would like ACE FOR FACE and SPF 15 both, every day
  I would like the benefits of ALOE VERA for hair and skin
FIRST NAME*:  
SURNAME*:  
EMAIL*:  
DAY TELEPHONE:  
EVENING TELEPHONE:  
MOBILE*:  
OCCUPATION:  
AGE:  
BEST TIME TO CALL:  
MORNING EVENING
THE FIELDS WITH THE * MUST BE COMPLETED   
 HAVE YOU TRIED ANY OF THE FOLLOWING PROGRAMS?
  Weight Watchers
  Herbalife
  Other
 WHAT IS YOUR WEIGHT LOSS/GAIN GOAL?
 
Until 5 kg 6-10 kg Up to 10 kg
 WHEN ARE YOU LOOKING TO LOSE/GAIN THE WEIGHT BY?
 
 
 WHY DO YOU WANT TO LOSE/GAIN WEIGHT?
 
 
 HOW MUCH WOULD YOU BE PREPARED TO SPEND PER DAY TO  ACHIEVE YOUR GOAL?
 
3,5 euro 5 euro 7 euro
COMMENTS
 
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