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Herbalife Independent Distributors

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Healthy Breakfast Questionnaire

Please complete this questionnaire to get yourself our
Free BREAKFAST *SAMPLE!

If you have a "Broadband" Internet Connection or
you have a Promotional Code
You can get your SAMPLE PACK *FREE!
*You only pay for shipping & handling. $7.50

Please answer all questions
*See what you'll get on the right.

*REQUIRED fields *What's your name?

*Postal address? (street )

*City?

*Region/State?(if applicable)

*Your e-mail address?

*Your PHONE number (including area code)?
*without a phone number this entry will not be processed

*1.Which of these words best describes your regular Breakfast?
Satisfying Temporarily filling Not filling at all Heavy

*2.Do you think you get 100% of the nutrition needed from your Breakfast?
Yes No Sometimes
*3.Do you take nutritional supplements (vitamins/minerals/proteins)for Breakfast?
daily Never Sometimes
*4.Do you experience a loss of stamina during the day?
Yes No Sometimes
*5.Do you or does any member of your family or friends need to lose or gain weight, or have more energy & vitality?
Lose weight Gain weight More energy
*What do you regularly have for breakfast? (regularly meaning Monday to Friday or about 80% of the time)...
*6.Check the different foods & drinks you regularly have for Breakfast:
coffee tea fruit juice milk protein shakes
cereal fruit toast eggs
bacon ham beans sausages
jam or spreads (i.e. vegemite/peanutbutter) nothing
*Other -describe

*if you want/need to lose weight...
7.*How much weight would you like to lose?
5-10kgs 10-15kgs more than 20 kgs N/A
*8.Do you eat a variety of healthy foods from the basic food groups throughout the day?
Yes No Sometimes
*If "NO", why not?
Too expensive Too complicated No time to prepare
*9.How many meals a day do you currently have?
1-2 a day 2-3 a day 3+ a day
*10.How much do you spend on food per day ?
$6-$12 a day $10-$15 a day $15+ a day
*11.Would you be interested in learning about a
DELICIOUS BREAKFAST program
to help you with more energy while controlling your cravings for excess
carbs or fat loaded foods?
Yes No
*If YES please answer the following:
What Time would it be best for us to reach you?
10am-12noon 12pm-2pm
2pm-5pm 7pm-9pm
How SERIOUS are you right NOW about improving the quality of your Breakfast?
serious very serious Not serious at all.
What AGE GROUP are you in?
18-26yo 27-36yo 37-46yo
47-56yo over 56yo
Our "BREAKFAST" programs cost under $3 per day, How would you find that?
reasonable just over my budget WAY over my budget
Please help us know...
*12.HOW DID YOU HEAR ABOUT US?
Advert in the local paper Flyer I came across someone
Poster Fax
Friend Google/Internet advert

*Do you have a "Promo Code" or have a "Broadband Internet Connection"?
Promo Code(Only pay for shipping & handling)
Broadband (Only pay for shipping & handling)
None of the above (We will be in touch with you)
*Do you have a VOUCHER with a special PROMO CODE?
(Only pay for shipping & handling)
(type CODE here)

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*Please click on "SEND" once after making sure your above details are correct

Have You Had Your Shake Today?
Learn more about all our range of Herbalife Products
Watch this Video:

Start your Day the Healthy Way!
We strongly believe that before you Start Your Day your BREAKFAST must provide you with what your body really needs.
Get a FREE BREAKFAST SAMPLE so you can make a WELL INFORMED DECISION about the MOST important meal of the day. Did you know that a bad breakfast can lead to...read more
This package will explain to you HOW our "Breakfast Programs" can work for you too!

We have countless success stories to prove this.

Testimonials (Weight loss success stories) click here
We believe everything starts at BREAKFAST TIME.
If we could all have a better, more nutritious breakfast which was "delicious, filling and satisfying" we could all have better health and vitality!
YOU CAN START MAKING PROGRESS TODAY!
Yes! - Anyone can do this, provided you are willing to make some simple changes to your start of the day.
Our HEALTHY BREAKFAST is for everyone!
There are primarily 3 types of breakfast...read more
IMAGINE THE BEST BREAKFAST EVER...
What would it be like?
Key facts that describe our Ideal Breakfast:
- Delicious.
- Easy & Practical to make by anyone anywhere!
- Versatile.
- Satisfying and energising.
- Helps control cravings for unwanted carbs or fats.
- Low in calories and fat.
- A valuable source of dietary fibre.
- Rich in vitamins and minerals, including the antioxidant vitamins A, C and E which can help protect against cell damage.
- Provides essential amino acids, (from protein) which the body cannot produce on its own.

*Available in five delicious flavours:
French Vanilla, Dutch Chocolate, Berry, Cookies 'n Cream and Tropical Flavour.
TRY THE ULTIMATE POSITIVE FAST-BREAKFAST!

Click to view.

"Our BREAKFAST SAMPLE Pack has been designed to give you the TIME to learn EXACTLY how our BREAKFAST PACK can work for you so you can feel fantastic EVERYDAY!
But most importantly You will be able to make a WELL INFORMED decision!"

Our BREAKFAST SAMPLE pack contains:
*Our Online Products Catalogue.
*Our Online VIDEO Presentation.
*Our "Ideal Breakfast" literature.
*You will also get our FREE BREAKFAST *SAMPLES!
*1 Sachet with 3 servings of our ShapeWorks Instant Herbal Beverage (For Energy to burn) and a sachet with our ShapeWorks Nutritional Shake (Vanilla) Mix!!
*click on image to enlarge

YOU'LL LOVE OUR FREE SAMPLES!

*Remember that regular exercise, balanced nutrition and a calorie controlled diet are the basic requirements of any successful weight control program.