Wellness Warrior Application
Do great things! Become a Wellness Warrior
What is your full name? *
Your answer
What is your Instagram or Facebook name? Please connect with me on FB: http://facebook.com/LindaWellnessWarrior IG:@LindaWellnessWarrior *
Your answer
What is your phone number and the best time to follow up with you? *
Your answer
What is your email address? *
Your answer
Have you ever worked with a wellness professional? If so, who and how long ago?
Your answer
What are your health & wellness goals? Why? *
Your answer
What is your Current Weight:_____ *
Your answer
What is your Height:_______
Your answer
Goal ____ How much weight do you want to lose / gain?
Your answer
Do you have stomach/hip/thigh fat or cellulite that you want to get rid of?
What other programs/products have you tried in the past to achieve your health goals?
Your answer
Do you eat three meals a day?
What did you have for breakfast, lunch and dinner yesterday?
Your answer
Go to snacks are
Do you take medications, vitamins or any type of nutritional supplements?
If yes, what kind / what for?
Your answer
What do you drink 32 fluid oz or more of daily?
How often do you eat out? #of____ days per week
Where to you eat or order the most take out? ______ Avg Cost per Meal $____
Your answer
Are you currently exercising? What type of exercise and how many times a week?
Your answer
What is your energy level, on a scale of 1 low, 6 do what I must, 10 High? *
Low
Unstoppable
Do you have any allergies, food or dietary restrictions? If so, please list
Your answer
Thank you for completing this warrior application! Please leave any additional comments below. I will be in contact with the next 48 hours.
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