New Client Questionnaire
In order for our coaches to better help create the perfect wellness plan for you, please fill out the questionnaire below and we will contact you after to setup your 1hr phone intake call.
1 = no stress 10 = a lot of stress
If you answer "yes" to any of these questions, please provide details such as date of occurrence, frequency, intensity, amount, etc.
YOUR CURRENT NUTRITION
Describe what you truly desire from completing our program. Be as honest and specific as possible, describing your dream body, lifestyle, or health. Pour yourself onto the page. Include anything that you feel would be helpful that you haven't yet had a chance to express. All your responses remain completely confidential.
By clicking 'Submit' below, you are agreeing to our waiver, terms and conditions:
Any and all prescribed, instructed, implied or suggested activities from Stronger Than Yesterday (collectively referred to as “The Released Party”), and all volunteers, agents, employees or independent contractors in any way associated with the Released Party, including, but not limited to all multi-sport related physical activities, outdoor endurance running and sprinting, running, jogging, and walking at a moderate to high effort on a grass surface; muscular stretching and flexibility exercises; body weight and calisthenic exercises, including push-ups, sit-ups, squats and lunges; plyometric and jumping activities including straight up and side to side jumping on surface such as rubber, grass, and asphalt; suggested take home exercises; open water swimming (for triathletes and swim lessons), often at depths above head level; weightlifting; rowing; stair climbing; indoor bicycling; bicycling on and off roads that are open to traffic; dismounting from bicycle; tracking nutritional intake; increasing or decreasing caloric intake; suggested meal plans, menus, or recipes; food supplementation; or any other activity prescribed, instructed or suggested from Stronger Than Yesterday and not listed in this document.
RELEASE OF CLAIMS, ASSUMPTION OF RISK, CONTACT AND WAIVER OF LIABILITY
I understand and am aware that this Activity is potentially hazardous. I acknowledge the possibility that injuries and physical and mental changes arising during and/or resulting from engaging in this Activity do exist. These injuries and changes include, but are not limited to, abnormal blood pressure, fainting, disorders in heartbeat, heart attack, joint injuries, and, in some instances, death. I understand injuries and changes could result in my becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life. I am voluntarily participating in this Activity with knowledge of the dangers involved. I understand and take sole responsibility for any and all injuries and changes that may occur to myself and/or others, including but not limited to Stronger Than Yesterday, related to any and all Activities associated with Stronger Than Yesterday, even if not specifically set forth in this document, whether or not they fall within the scope of reasonably foreseeable injuries related to this Activity, and whether or not undertaken in the presence of staff or physical location of Stronger Than Yesterday. Although Stronger Than Yesterday will take precautions to ensure my safety, I expressly assume and accept sole responsibility for my safety and for any and all injuries and changes that may occur. I release Stronger Than Yesterday and all coaches in any way associated with the Released Party from any and all liability for any personal injury, death, property damage or loss I may suffer as a result of, arising from, related to or in any way connected to my participation in this Activity, and for any cause whatsoever including negligence, including active negligence, passive negligence or gross negligence on the part of Stronger Than Yesterday and all coaches in any way associated with the Released Party. I declare myself physically and mentally sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation in this Activity. I acknowledge I have been informed of the need for a physician’s approval for my participation in an exercise/fitness Activity. I recognize it is my sole responsibility to obtain an examination by a physician prior to involvement in any exercise program. I acknowledge I have either had a physical examination and been given my physician’s permission to participate, or if I have chosen not to obtain a physician’s permission prior to beginning this Activity, I acknowledge I am doing so at my own risk. I understand that if under any circumstances I experience lightheadedness, dizziness, muscular pain, excessive fatigue or any other painful or uncomfortable signs that exceed normal exercise fatigue, I am not obligated to continue this Activity. Furthermore, I may stop this Activity at any time as I desire. Stronger Than Yesterday’s coaches are not Physicians or Registered Dieticians. They do not diagnose or treat disease. I have been informed that I should consult a Physician before undergoing any dietary or food supplement changes. Any recommendations or suggestions from Stronger Than Yesterday for changes in my diet, including but not limited to the use of food supplements, food substitutions, caloric intake, meal plans, recipes, and menus are entirely my responsibility, and I release Stronger Than Yesterday from any and all liability for any illness, personal injury, death, property damage or loss I may suffer as a result of any change in my nutrition, diet, or food intake. I acknowledge and agree no warranties or representations have been made to me regarding the results I will achieve from this program. I understand results are individual and may vary. This Waiver and Release shall be governed by the laws of the State of Nevada. All disputes arising from this Waiver and Release Agreement, and participation in any Activity, whether in Contract, Tort or Equity, shall be brought in the State of Nevada. By signing below, I agree to subject myself to the jurisdiction of Nevada and thereby waive any argument of lack of personal jurisdiction or forum non conveniens. I acknowledge I have thoroughly read this waiver and release and fully understand it is a waiver and release of liability. By signing this document, I am waiving any right I, or my heirs and/or assigns, may have to bring any and all legal actions or assert any and all claims against Stronger Than Yesterday, its respective representatives, executors, and/or assigns. I confirm that I have read over this agreement before signing, that I understand it, and that it will be binding not only on me but also on my heirs, my next of kin, my executors, administrators and assigns. I represent and warrant I am signing this agreement freely and willfully and not under fraud or duress. I further represent and warrant no social relationship exists between Stronger Than Yesterday and me, or if such a social relationship exists, for purposes of my training sessions, Trainer and I have assumed a strict business relationship, and I understand any social relationship does not render this waiver invalid. These exculpatory clauses are intended to apply to any and all activities occurring during the time for which I have contracted with Stronger Than Yesterday.