Wellness Evaluation

Wellness Evaluation with Tasha Robitaille

Hi! Thank you so much for landing yourself here, you are amazing! My name is Tasha Robitaille and I am a Wellness Coach aligned with Herbalife Nutrition. I really look forward to connecting with you and helping you achieve your best self in mind, body and soul. Please fill out the form and I will personally contact you within 48 hours to help you get started.

*SERIOUS INQUIRIES ONLY PLEASE.

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* Contact Information

First and Last Name

City/Town

Email Address

Phone Number

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* Tell me a little about yourself (i.e., where you are at in your life journey and why).

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* Coaching Interest (select all that apply)

I want to focus on weight loss and/or toning.

I want to focus on wellness (e.g., energy, bloating, etc.).

I want to focus on gaining lean muscle mass.

I want to focus on sports performance.

I want to focus on my mindset and/or leadership skills.

Other (please specify)

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* How much do you exercise?

Never/Not Yet

1-2 Times/Week

3-5 TImes/Week

Most Days/All Week

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* How many times a day do you eat (i.e. meals and snacks)?

Only once.

2-3 Times/Day

4-6 Times/Day

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* How much money do you spend daily on drinks, snacks and/or meals?

$0-5

$5-10

$10-20

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* What is your relationship with Herbalife Nutrition?

I have never used it and I am interested in getting started.

I have used it before and would like to try it again.

I have worked the business before and would like to start again.

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* Are you also interested in learning how to earn additional income with Herbalife Nutrition?

Yes

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* Are you interested in starting this journey with anyone that you love, like or trust? (Shh....secret - it's way more fun!)

Yes

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* On the scale below, how serious are you in changing your life?

Just Curious

Serious in Starting

I Want to Start Today!

Clear

i We adjusted the number you entered based on the slider’s scale.