Please fill out the form below so I can prepare for your appointment.
Best Email (please use the one you gave for the appointment booking)
What is your primary health concern?
How does it affect your life or what does it prevent you from doing?
How long has it been going on for?
What have you tried in the past to improve these things?
Being really honest, what is the biggest obstacle or challenge that stands in your way?
What are 3 things you LOVE about your life?
Right now, I...
Have the financial means to invest in my health.
Have access to the financial means to invest in my health.
I have no financial means & I'll probably stay on my current health path
On a scale of 1-10, how committed are you to getting the results you are seeking?
1=not really, 10=110%! I'm ready
I will call you at the time you chose. Please commit to your appointment by typing this sentence in the box below: "Yes, I promise I will answer the phone for my breakthrough session when my coach calls."
Is there anything else you'd like to share with me?
Kim Heintz, Inc.
Stay Logged In
Enter Member Area
(Message automatically replaces this text)