TONED BY KIM - CLIENT INTAKE FORM

TONED BY KIM - CLIENT INTAKE FORM
Full Name*

First NameLast Name
Address*

Street Address

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CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
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Where did you hear about us?*
Date of Birth*

MonthDayYear
Height*
ft
Weight*
lb
Target Weight*
lb
At what times during the day would you prefer a 30min consultation?

MorningMid-DayAfternoonEvening
What do you do for a living?*
Do you follow a regular working schedule, do you work days, afternoon or nights?*
What is your Activity Level per Week?*

InactiveActive (3)Moderate (1-2)Very Active (4+)
What are your Priorities?*

Lose WeightLean and ToneBuild MuscleOverall Health
Please list the physical activities that you participate in outside of the gym and outside of work.:*
If you have any diagnosed health problems list the condition(s).*
Are you experiencing any stress or motivation problems?*

YesNo
Your current diet could be best characterized as:*

low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
What TBK programs are you interested in?

6-Week Lifestyle Reset (Reset my body, restore routine, and build a stronger foundation)12-Week Elite Transformation (I want a clear goal, structure, and premium coaching to reach my next level)Train With Kim (I want to build a solid base first and grow into the next phase if it’s right for me)Small Group Coaching (I’d love to train with a small, supportive group of women — possibly with friends)
What do you expect from me as your coach?
What is your goal with this program?
How soon are you ready to Start?*

TodayThis weekNext WeekNext Month
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Date of Submission*
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