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Intake Form

Fill out this form and we will contact you as soon as possible.

Do not fill out this form if you are an active Herbalife Member with another coach.

Check all that apply.
Have you tried Herbalife before?
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No
If yes, how long ago did you order products?
Have you ever been an Herbalife member?
Yes
No
If yes, how long ago did you sign up?
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