Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Best Time To Call
*
Before 9am
9am-12 noon
12 noon-3pm
3pm-6pm
After 6pm
Best Means of Communication
*
Call
Text
Email
What results are you looking to achieve?
Lose Body Fat
Get Lean & Toned
Improve Energy Levels
Increase Lean Muscle
Other
How long have you been struggling with weight loss, muscle gain or your energy level?
Never
Under 6 months
12 months
1-2 years
2-5 years
Over 5 years
On a scale of 1-10 how important is it for you to achieve the above goals/challenges?
Please Select
1
2
3
4
5
6
7
8
9
10
What have you tried in the past to achieve your goals?
What have prevented you from achieving your goals in the past?
What do you see as your biggest challenge with the goals?
6 WEEKS SIGNATURE MIND BODY TRANSFORMATION
I am excited to have the initial virtual assessment and the opportunity to review the final results at the end of the 6 weeks! I’ll be happy to stay in communication with Kim on the portal throughout the program, without the need for the weekly Zoom meetups
6 WEEKS PREMIUM MIND BODY TRANSFORMATION PROGRAM
I am excited to have the initial virtual assessment and the opportunity to review the final results at the end of the 6 weeks! I would like the support of the weekly Zoom check-ins with Kim, as well as the interactive check-ins on the portal throughout the program. WEEKLY LIVE MEETUPS will be incredibly helpful for accountability and provide additional support to achieve my transformation! In addition to all, IN ADDITION TO ALL, I would also like to receive nutrition supplements recommendations to maximize my results in 6 weeks!!!!
I AM INTERESTED IN
Please Select
6 WEEKS SIGNATURE
6 WEEKS PREMIUM
OTHERS
APPLY NOW
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