Customize Your Program
Prospect Outcome
Not Signing Up
Signing Up
Client Name
Trainer Name
Reason for Declining Service
Submit
Choose Your Goal
Muscle Shape, Strength, & Stamina - You Need a Personal Trainer
Weight Loss &/or Healthy Function - You Need a Registered Dietitian
Both Fat Loss & Muscle Development - You Need BOTH Trainer & Dietitian
Personal Training Frequency
Palladium - (5 customized sessions per week)
Platinum - (4 customized sessions per week)
Gold - (3 customized sessions per week)
Silver - (2 customized sessions per week)
Bronze - (1 customized session per week)
Intensity of Dietitian Interaction
100 %: Weekly VideoChats, Daily Accountability, & Monthly Consults
80 %: Weekly VideoChats & Daily Accountability
60 %: Twice a Month VideoChats & Daily Accountability
40 %: Simply Daily E-Accountability
20 %: Weekly VideoChats Only
Participation
Individual
Shared
Final Monthly Investment
Service to Start on:
-
Month
-
Day
Year
Date Picker Icon
Service to End or Renew on:
-
Month
-
Day
Year
Date Picker Icon
Service Schedule & Missed Session Policy:
*
Any sessions NOT redeemed within this time period WILL BE FORFEITED. If at any time, I need to cancel a scheduled session, I must provide at least 24 HOURS ADVANCED NOTICE to my trainer, OR FORFEIT THE SESSION. If I must miss a regularly scheduled session, it is imperative that I make EVERY effort to make up the session as soon as possible, reducing the risk of forfeiture. No refunds will be given, NOR CAN THIS AGREEMENT BE EXTENDED. I can, however, upgrade at any time to a higher level of accountability and results.
Company Team Support:
*
I also acknowledge that I am entering an agreement with Elect Wellness, not a specific personal trainer or nutrition coach. From time to time, Elect Wellness may choose to assign a personal trainer or nutrition coach to complete my agreement other than the ones that began servicing my agreement. However, in the event that I am not satisfied with my personal trainer or nutrition coach, I have the right to request another.
Agreement Cancellation Terms:
*
If, for some reason, I quit on my commitment, I the client agree to pay a cancellation fee of 33% of regular monthly payment. I understand that I will not be refunded any money already paid, and have 30 days from my last scheduled payment to redeem any outstanding sessions.
Understanding Why:
*
I fully understand that these terms & conditions are instituted so that Elect Wellness can continue to offer professional services &, most importantly, I can continue to make progress & achieve my health & fitness goals. If I am not satisfied with Elect Wellness, I can cancel anytime within the first 30 days of this agreement, & receive a full refund.
Convenient Continuation of Agreement:
*
For my convenience and the continuation of a healthy lifestyle, working out regularly and eating right, without 30 days notice of cancellation by me, the client, this agreement will auto-renew under the same conditions, and commence again on the aforementioned ending date.
Scope of Service
*
Elect Wellness team members are fitness and nutrition professionals providing fitness and nutrition services. I understand that Elect Wellness employees are not educated, trained, licensed, certified, or insured specifically for … and can NOT provide … home help (i.e. assistance with bathing, dressing, grooming, housekeeping, transportation, medication administration, etc.)
Coach Employment Policy
*
Elect Wellness makes substantial monetary and time investments in searching, filtering, interviewing, testing, hiring, training, employing, and continually educating each of its team members. In recognition of that investment, I the client agree not to directly or indirectly hire any employee of Elect Wellness for a period of one year from the last date on which the employee worked with me without obtaining written consent of Elect Wellness. If I the client violate this provision, then I shall be liable to Elect Wellness for $15,000 per employee hired in liquidated damages. I the client agree that the damages suffered by Elect Wellness would be difficult to ascertain, and that these amounts are intended to reasonably compensate Elect Wellness for damages that would occur if its employees are hired directly or indirectly by me.
Full Name
First Name
Last Name
Today's Month
Today's Day
Today's Year
E-mail (for copy)
*
Signature
Payment Perspective:
*
I understand that Elect Wellness is extending a 0% interest payment plan option for the service total agreed upon, & in choosing that option, I understand these payments are due on a specific schedule. I further understand that I am receiving a discounted rate for my chosen frequency of coaching & the duration of my commitment. The recurring auto debit is not only for the efficient delivery of my service, but also for my convenience.
I, ____________ authorize Elect Wellness
First Name
Last Name
... to charge ________ to my credit card today ...
and ___________
... on the __________ of each month for my health and fitness coaching and consulting services.
Signature
Submit
Should be Empty: