Waist Training Intake Form
Please complete this form to help us understand your goals, health status, and preferences for your waist training program.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
*
Female
Male
Non-binary
Prefer not to say
Other
Body Measurements
*
Rows
Measurement (inches)
Waist
Hips
Underbust
Torso Length
What are your primary goals for waist training?
*
Reduce waist size
Improve posture
Support for back pain
Postpartum support
Enhance figure/curves
Other
Do you have any of the following medical conditions? (Select all that apply)
*
Heart condition
Respiratory issues (e.g., asthma)
Digestive disorders
Recent surgery
Pregnant or breastfeeding
None of the above
Other
Describe your current activity level
*
Please Select
Sedentary (little or no exercise)
Lightly active (light exercise/sports 1-3 days/week)
Moderately active (moderate exercise/sports 3-5 days/week)
Very active (hard exercise/sports 6-7 days/week)
Super active (very hard exercise & physical job)
Do you have previous experience with waist training?
*
Yes
No
If yes, please describe your previous waist training experience (type, duration, results, etc.)
Preferred type of waist trainer/corset (if any)
Please Select
Underbust corset
Overbust corset
Waist cincher
No preference
Other
Is there anything else we should know about your health, lifestyle, or goals?
Signature (please sign below to confirm your consent)
*
Submit Intake Form
Submit Intake Form
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