NEW CLIENT FORM |bodyclinic

NEW CLIENT FORM

Pre Assessment Form

First Name

Last Name

Phone

Gender

Male

Female

List any current or past medical conditions including heart conditions, cancers, metabolic conditions:

Are these medical conditions being monitored by a physician? YES / NO

List any current medications you are taking:

List any current injuries or movement restrictions that you want to improve:

List all previous surgeries.

Are you at a stage where you are ready to commit to making changes to your health and fitness? Why are you motivated now?

What are the main issues you are currently having with your health and fitness?

If you were to describe a successful coaching experience what would it look like?

Describe your current eating habits below – list number of meals, dietary preferences etc.

Body Clinic Liability Release and Waiver

Client (from now on referred to as “you)” acknowledges and is fully aware that Body Clinic Sydney is not comprised of medical doctors, and that Nigel Morgan is a Registered Physiotherapist and Exercise Physiologist.
You acknowledge and are fully aware that Body Clinic Sydney and Nigel Morgan are only providing nutrition recommendations.
You are aware that before beginning or implementing any exercise, rehabilitation or nutrition program consulting a physician is advised.
You understand that Body Clinic Sydney and Nigel Morgan cannot and does not offer any guarantees and that we do not offer refunds.
You acknowledge that participating in any exercise, rehabilitation or nutrition program carries with it a potential risk of harm and that Body Clinic Sydney and Nigel Morgan are not responsible for any injuries or illnesses potentially sustained through participating in their programs.
You acknowledge that there is a 24hr cancellation policy for all in person consultations. If cancellation is made within the 24hr period, Body Clinic Sydney and Nigel Morgan reserve the right to charge the full fee at their discretion
The first 4 weeks of consulting is paid upfront, with a weekly payment model followed thereafter.

I client, waive, release and forever discharge and hold harmless Nigel Morgan and Body Clinic Sydney from any and all responsibility, liability, cost and expenses, including injuries or damages, resulting from my participation in any activities, or my use of any programs including nutrition and rehabilitation, designed by Nigel Morgan and Body Clinic Sydney.

By clicking below, I fully agree to the above referenced terms.

I accept terms & conditions

Thanks for submitting!

GET IN TOUCH

SOCIAL | @bodyclinicsydney

ADDRESS | 259 George street, Sydney CBD

PHONE | 0410148296

EMAIL | nigel@bodyclinicsydney.com