Training with Kim

COMPLIMENTARY CONSULTATION
Thank you for accepting a free one hour consultation.

Your consultation will include:
• One-on-one meeting with KIM
• Tour of the studio
• Exercise recommendations based on your needs

Discuss information such as:
• Goals
• Health history/Injuries
• Program design

Please complete the following information to assist Kim in making the most out of your consultation

Items with an asterisk(*) are required.

First Name:*	Last Name:*
Address 1:*
Address 2:
City:*	State:*	Zip:*
Home Phone:	Cell Phone:	Work Phone:
Email:*		Best time to call:
Birthdate:* mm/dd/yyyy	Gender: M F	Pregnant? Number of months
Has a physician ever advised you against exercise? Yes No
If yes, please explain.
Any injuries or health concerns?
How do you rate your overall health: Poor Fair Good Excellent
Describe your current exercies routine (if any)
Describe your main fitness goals
What day/time works best for you:
How id you hear about TRAINING WITH KIM?