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12 Week Coaching Program Application

Fill out this 5-minute application to get you started in the program! 

Click the button below to start.

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Question 1 of 14

How did you hear about K.I.M. Keep It Movin' with Kim? Why do you feel like my programs would be a good fit for you?

Question 2 of 14

What is your social media handle for Facebook or Instagram? I'd love to follow you!

Question 3 of 14

What are you hoping to achieve with this program?

Question 4 of 14

Why is now the time to achieve it?

Question 5 of 14

What are your biggest health struggles right now, how long have you been dealing with them, and what have you tried for them? 

Question 6 of 14

What are you struggling with the most when it comes to succeeding in this goal?

Question 7 of 14

What prior investments have you made in your health journey and what was your favorite investment?

Question 8 of 14

Are you prepared to go outside your comfort zone in order to make effective and lasting changes in your health and wellness? (no bikini pics, I promise, more open mindedness about how to get from point A to point B)

A

Hells yes!

B

Ummm, hard pass!

C

How far outside my comfort zone...asking for a friend 😉

D

Other

Question 9 of 14

Where do you want your health and your life to be 6 months from now?

 

Be as descriptive as possible. 

Question 10 of 14

Which of the following have you worked with in the past or are currently working with? 

(Select all that apply)
A

Medical Doctor / Primary Care Physician

B

Nutritionist or Dietician

C

Therapist

D

Physical Trainer

Question 11 of 14

On a scale of 1 to 10, how committed are you to making changes to address your health complaints? Zero being not very close and 10 is I'm done messing around I'M ALL IN!

Question 12 of 14

The investment is $1500 for 3 months (paid in full or monthly).  If we both agree this is a good fit for us to work together, are you ready to make the investment in your health and yourself?

A

I am sooooo worth this investment...I am all in!! (paid in full or monthly payments)

B

I am scared out of my mind and have a few questions!

C

No, I am not ready to invest at this time.

Question 13 of 14

What is the best time for 1 hour weekly call? (All times indicated in EST time zone)

A

Before 8am

B

Noon

C

8pm

D

Other

Question 14 of 14

Is there anything else you'd like for me to know?

Confirm and Submit