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Weight Gain Questionnaire     

This questionnaire has been designed to establish your personal requirements for gaining weight. Please answer all of the questions below by ticking the appropriate box.

Serious enquiries only please. Experienced consultants available to offer advice by phone. Hard to contact then call us on 01673 838 916.

1.What are your meal patterns like 

3 meals a day

More than 3 meals a day

Irregular meals

Less than 3 meals a day

2.Do you

Eat lots of food and not put on weight

Have a poor appetite

3.What are your energy levels like

Below average

Average

Above average

4. Do you smoke?

Yes No

5.Give yourself a rating on negative nutrition (smoking, coffee drinking, fast food, processed food, stress medication) out of 10. High negative = low number.

6.How have you tried to gain weight before?

7.Do you play sports or exercise or go to the gym? Please advise details

8.What type of work do you do ie office work or physically demanding work?

9.How old are you?

10.How tall are you?

11.How much do you weigh?

12.How long have you been at this weight

13.What is your ideal goal weight?

14.Addditional information:

15.How serious would you say you are about your gaining weight?

    1. Extremely serious              
    2. Fairly serious                    
    3. It doesn't really worry me   

16.How serious would you say you are about maintaining long term good health by looking after your body now?

 

    1. Extremely serious              
    2. Fairly serious                    
    3. It doesn’t really worry me   

Name 

Telephone Evening 

Telephone Day

Best time to call Telephone consultations between 9am -9 pm on landline telephones only. Hard to contact, never in, no landline number? Phone us on 01673 838 916 after after completing the questionnaire. Please contact us at least 30 mins after filling in the questionnaire. Best time to reach us is 1- 9pm

Please check your contact details or we cant help you..

Additional comments/information required e.g. questions need answering, recommended programme

  

Success Story 1

 Hi my name is Hein G and I'm a student from London.

Before I started using the Herbalife products I had several problems that kept me back from being the best I can be.

My energy was very low and I was forced to sleep in the afternoons because I just couldn't get through the day without it.

I was under weight and that made me feel small and insecure which affected my posture and confidence.

But on top of all of this I had terrible skin. My face, chest and back were covered in huge red spots, big ugly ones. Yuck!

This had an enormous effect on me. I felt ashamed of my appearance and refused to go out and avoided all social events. I had the posture and self-confidence of a worm. People could see it and because of that they treated me like a worm.

I tried everything on the market and went from specialist to specialist spent a fortune over a period of 10 years and nothing worked.

Herbalife walked into my life. I started using Herbalife's Inner Nutrition products and my life began to change.

My energy skyrocketed, I didn’t need to sleep in the afternoon and I even woke up before my clock rang in the morning. It was great!

I managed to gain 5kg (that is 10 lbs. in English money) in 3 months and together with my energy-result it started to boost my confidence a little.

After this fantastic results I then started using Herbalife's Outer Nutrition products and my life changed completely.

Thank you Herbalife!

 

Success story 2

Hi my name is Phillip J, before using these amazing Herbalife products, I had tried years to gain weight with out success.

The best part is that in the first 6 months on the products I gained 10kgs [22 pounds] of muscle. Since then I gained an extra 12kgs of muscle and also lost 5kgs of body fat while I reduced my training dramatically. I have gained a total of 22kgs [48.4 pounds] of muscle following the program and maintained the weight, even when I don't train.

When I first used the products I had an incredible energy lift, which was much needed, since I had energy drop out everyday from as far back as I could remember. Even as I went through high school I always felt run down and fatigued.

My last two major results on the products have being a reduction in pain to my shoulder, to the point where I no longer need to have an operation. The other is my hernia (tear in the lower groin), which I suffered with in January 2001. Thanks to the products I was able to rebuild the tear to the point where the pain that I suffered with day in day out has stopped.

Also I suffer with Type 1 Diabetes, which means I'm Insulin dependent. on these amazing products I find it so easy to maintain my sugar levels, they're great!