Your Name (required)
Your Email (required)
Your Phone Number (required)
1. Do you consume caffeine?
2. Are you hungry when you wake up?
3. What time do you eat your first meal of the day?
4. What do you typically eat for your first meal of the day?
5. Do you like to eat mini meals or big meals?
6. Please describe your next meals of the day before dinner. What time- where do you eat them, and what do they typically consist of?
7. Do you currently workout? If so, how many days per week and what time of day?
8. How many minutes of cardio do you get in a week?
9. Do you have any food intolerances or sensitivities?
10. Are there any foods you dislike?
11. What foods do you typically crave?
12. Do you need variety in your meals or could you eat the same things each day?
13. What do you feel is the hardest part of sticking to a diet plan?
14. How much protein/carbs/fat/ and calories are you currently getting?
15. How much do you currently weigh?
16. What is your goal weight?
17. How old are you?
18. How tall are you?
19. Do you currently take any supplements? If so, what are they?
20. Is there anything else that you want us to know?
20. PAYMENT AND LIABILITY CONTRACT
By this contract, I agree to make payments in the full amount by the 5th of each month in exchange for any services provided by Peak Physique, LLC and affiliates.
In the event that I wish to cancel recurring services, I understand that I am required to communicate my need for cancellation before the last day of the month that has been purchased.
I also acknowledge that Peak Physique, LLC will retain the right to issue no refunds after my purchase.
I, the undersigned, being aware of my own health and physical condition, and having knowledge that my participation in any exercise and nutrition program may be injurious to my health, am voluntarily participating in a physical activity.
Having such knowledge, I hereby acknowledge this releases Peak Physique, LLC and any and all representatives, affiliates, and associates from all liability for accidental injury or illness which I may incur as a result of participating in the said physical activity or dietary recommendations. I hereby assume all risks connected therewith and consent to participate in said program.
I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in said programs.
The full Payment and Liability Contract has been carefully read and fully understood by the undersigned. The terms have been explained to me and I am freely, knowingly and voluntarily entering into this Contract.
I understand and agree to all terms.