JumpStart Session - Client Intake

Let's Get Started

Quick basics so we can personalize your session

Full Name

Email Address

Phone Number Required for account login and appointment reminders

Your Timezone

Your Numbers

These help us understand your starting point

Accurate numbers make all the difference. If you have a scale nearby, now is a great time to step on it — the more precise your data, the better your plan.

Age

Height

Current Weight (lbs)

Health History

Help us understand your medical background

Any other conditions or details we should know about?

Are you currently taking any medications?

Yes No

What supplements do you currently take? (if any)

Do you have any food allergies?

Yes No

Do you follow any dietary restrictions?

Vegetarian Vegan Pescatarian Dairy-free Gluten-free Religious (Kosher, Halal, etc.) None

Have you consulted with a physician about starting a new nutrition or exercise program?

Yes No I plan to

Your Goals

What are you looking to achieve?

What is your primary goal?

Fat loss / body recomposition Increase energy levels Improve physical performance Overall health optimization Other

How important is achieving this goal to you right now?

1 - Not very 5 10 - Extremely

If we're successful over the next 90 days, what does that look like for you? 0/1000

What's your biggest fear or concern about starting this program?

How would you rate your current daily energy level?

1 - Very low 5 10 - Excellent

How many times have you tried to lose weight or improve your health in the past?

This is my first time 1-2 times 3-5 times More than 5 times

What has worked for you in the past?

What has never worked for you?

What is the #1 thing that has been blocking you from achieving your goals?

Your Lifestyle

Help us understand your daily routine

How many days per week can you realistically commit to training?

0-1 days 2-3 days 4-5 days 6-7 days

Are you currently exercising?

Yes, regularly Yes, but inconsistently No

How often do you travel for work or pleasure?

Weekly Monthly Occasionally Rarely/Never

How often do you eat out or order takeout?

Daily 4-6 times per week 2-3 times per week Once a week or less

How would you rate your current stress level?

1 - Low 5 10 - High

How many hours of sleep do you typically get?

Less than 5 hours 5-6 hours 7-8 hours More than 8 hours

How would you rate your sleep quality?

Excellent - I wake up refreshed Good - Usually sleep well Fair - Some issues Poor - Struggle with sleep

Is there anything else you'd like us to know before your session?

How did you hear about Man vs Health?

Service Agreement

Please review and acknowledge the following

MAN VS HEALTH COACHING CLIENT SERVICE AGREEMENT

Effective Date: Upon electronic acknowledgment

1. SCOPE OF SERVICES

Man vs Health ("Coach," "we," "us") provides health and wellness coaching services, including but not limited to nutritional guidance, exercise programming, lifestyle optimization, and accountability support. Services may be delivered through one-on-one consultations, digital platforms, text messaging, email, and/or proprietary software applications.

2. NATURE OF SERVICES

IMPORTANT: The services provided by Man vs Health are coaching and educational in nature. We are NOT licensed medical professionals, registered dietitians, or certified nutritionists (unless specifically stated). Our services do NOT constitute medical advice, diagnosis, or treatment.

You should consult with a qualified healthcare provider before starting any new nutrition, exercise, or wellness program, particularly if you have pre-existing medical conditions, take medications, or have concerns about your health.

By proceeding, you acknowledge that:

Coach is not a medical doctor, nurse, or licensed healthcare provider
Coaching services are not a substitute for professional medical advice
You are responsible for consulting appropriate medical professionals
Results vary and are not guaranteed

3. PAYMENT TERMS

Payment is due at the time of purchase. All fees are non-refundable except as specifically outlined in our Refund Policy. Subscription services will automatically renew unless cancelled prior to the renewal date.

4. REFUND AND CANCELLATION POLICY

Consultation/session fees are non-refundable once the session has been delivered. For subscription services, you may cancel at any time, but no refunds will be issued for partial billing periods. If you are unsatisfied with your service, please contact us within 7 days to discuss your concerns.

5. TERMINATION

Either party may terminate this agreement at any time with written notice. Upon termination, any outstanding fees become immediately due. Coach reserves the right to terminate services if Client engages in abusive behavior, fails to follow safety guidelines, or violates the terms of this agreement.

6. CLIENT RESPONSIBILITIES

As a client, you agree to:

Provide accurate and complete information about your health history
Inform Coach of any changes in your health status or medications
Follow safety guidelines and modifications as recommended
Communicate openly and honestly about your progress and challenges
Take responsibility for your own health decisions

7. ASSUMPTION OF RISK & LIABILITY WAIVER

IMPORTANT - PLEASE READ CAREFULLY:

You understand and acknowledge that physical exercise and dietary changes carry inherent risks, including but not limited to: physical injury, aggravation of pre-existing conditions, and in rare cases, serious health consequences including heart attack, stroke, or death.

By accepting this agreement, you voluntarily assume all risks associated with participating in our coaching programs. You release and hold harmless Man vs Health, its owners, employees, contractors, and affiliates from any and all claims, damages, or liability arising from your participation in our programs.

8. CONFIDENTIALITY & PRIVACY

We respect your privacy and will handle your personal information in accordance with our Privacy Policy. Your health information and progress data will be kept confidential and will not be shared with third parties except as required by law or with your explicit consent.

9. DISPUTE RESOLUTION

Any disputes arising from this agreement shall first be addressed through good-faith negotiation. If unresolved, disputes shall be settled through binding arbitration in accordance with the rules of the American Arbitration Association. This agreement shall be governed by the laws of the State of Florida.

10. INTELLECTUAL PROPERTY

All program materials, meal plans, workout protocols, and content provided by Man vs Health are proprietary and protected by copyright. You may not reproduce, distribute, or share these materials without written permission.

11. MARKETING & TESTIMONIALS

With your permission (granted separately below), we may use your testimonials, progress photos, and success stories for marketing purposes. You may withdraw this permission at any time by contacting us in writing.

12. GENERAL PROVISIONS

This agreement constitutes the entire agreement between the parties. If any provision is found unenforceable, the remaining provisions shall remain in effect. Coach may modify these terms with notice to Client. Continued use of services after notification constitutes acceptance of modified terms.

Required Acknowledgments

Please check each box to confirm your understanding:

I have read and understand this Service Agreement

I understand this is a coaching and educational service, NOT medical care

I assume all risks and accept full responsibility for my health decisions

I understand that results are not guaranteed and vary by individual

I agree to binding arbitration for any disputes

Digital Signature

Type your full legal name to sign electronically

Date:

Optional: Testimonials Permission

I give Man vs Health permission to use my testimonials, progress updates, and success story for marketing purposes. I understand I can withdraw this permission at any time.

Welcome to Your JumpStart Session