Client Sign Up

Please complete this form to sign up for my services.

First Name

Last Name

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Age

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What do you do for a living?

If you decided to change, on a scale of 1-10, how confident are you that you could change, when 1 represents not at all confident and 10 equals extremely confident?

If you had to be on a reality TV show, which one would you choose and why?

Tell me what else is going on for you right now, in your life. What else do you have on your plate besides this? Let’s get a sense of what you’re working with.

What is the main reason why you're interested in my nutrition coaching?

You can have an unlimited supply of one thing (other than money) for the rest of your life, what is it? Sushi? Scotch Tape?

RELEASE, WAIVER AND LEGAL DISCLAIMER By clicking submit you acknowledge that you have read and accept the terms of Stronger U’s release, waiver, and legal disclaimer. To consult a physician prior to beginning any exercise or diet program. STRONGER U, LLC, its principals, employees, agents, coaches, representatives or any other individual or entity actually or apparently affiliated with STRONGER U (herein after “STRONGER U”) are not licensed physicians or medical providers. In no way should the information provided by STRONGER U be considered medical advice, and at all times the advice of a medical professional should supersede recommendations from STRONGER U. STRONGER U assumes no responsibility for the improper use of, and self-diagnosis using, the information conveyed as part of the nutritional coaching program. The information contained in the nutritional coaching program of STRONGER U is provided for informational purposes only and is not meant to act as a substitute for the advice provided by your own physician, or other medical professional. Only your doctor can determine what is healthy, right or safe for you. Clients who fail to consult their physician(s) prior to starting a diet or exercise program expressly assume the risk of any adverse effects. None of the information provided by STRONGER U is intended to be a treatment protocol for any disease or medical condition, but rather is offered to provide information and choices regarding nutritional and diet support. The prior results reported are not in any way guaranteed and may not occur in all individuals. STRONGER U provides its services on an “as is” basis and makes no representations or warranties of any kind with respect to its information, website, promotional materials, articles, blog posts, advertorials, nutritional coaching or any other information conveyed. Please consult your own physician or health care provider about the applicability of any opinions or recommendations with respect to your own symptoms or medical conditions, if they exist. STRONGER U shall not be liable for damages arising out of or in connection with the use of its services. These services are not intended to diagnose, treat, cure or prevent any disease. The information provided by STRONGER U has not been evaluated by the FTC, FDA or any other governmental, regulatory, industry or professional agency. Use of the nutritional and/or exercise information provided by STRONGER U is at the sole choice and risk of the client. STRONGER U is not responsible, nor liable, for any harm or injury resulting from the use of the information provided by STRONGER U. Always consult your doctor before making any changes to your exercise, diet or nutrition program. If you choose not to obtain the consultation, advice and consent of your physician while using any information provided by STRONGER U, you are agreeing to accept full responsibility for your actions. STRONGER U is committed to the privacy of its clients and their personal information, data and images ("Information"). STRONGER U does not provide, sell or otherwise share any such Information to any third party. Such information is used only internally by STRONGER U to better serve its clients. STRONGER U may from time to time aggregate data from multiple clients in the form of statistical analysis (such as weight loss or satisfaction survey results) and share such statistics, with no personally identifying information, to exemplify the benefits of STRONGER U services, and Client hereby consents to same. In no event would the Information of individual clients be shared without the express written consent of the Client. Such written consent may be in the form of any electronic method of communication (email, text, Facebook message) regularly and reliably used by the Client in their communications with STRONGER U or its agents. Any person under the age of 18 years old requires the written consent of a parent or guardian prior to working with any STRONGER U employees or agents. I have read the foregoing and fully understand the need for me to consult with my own medical practitioners prior to beginning this program. Further I release and indemnify STRONGER U from any and all claims arising out of my use of STRONGER U’s services.