💪 Kiana Fitness Health Assessment

Kiana Fitness Health Assessment

Helping you look and feel your best from the inside out!

Your starting point to a custom workout plan

Name

Age

Gender

Email

example@example.com

Phone/Text

Format: (000) 000-0000.

What equipment do you have

Days per week you can workout

Work Schedule

If I waved my Magic Kianas Flex Appeal wand what would you want to change about your body

Do you have any injuries or physical limitations I should know about

Would you like to add anything else about your fitness goals or lifestyle

If yes please explain

I'm interested in the Fuel Food Plan - clients typically lose 8-12 lbs in 30 days

Waiver, Release & Assumption of Risk By participating in the Kiana Fitness Program, I acknowledge that physical exercise involves inherent risks. I voluntarily assume all responsibility for any injury, illness, or condition that may occur as a result of participation in workouts, use of recommended equipment, or nutrition programs. I release and discharge Kiana Tom Productions, Inc. and Kiana Tom, including all employees, affiliates, and representatives, from any and all liability, claims, demands, or causes of action related to participation in this program. I affirm that I have consulted with my physician or am in adequate health to begin a fitness and nutrition plan. I agree to the terms above.

Name

Signature

Date