MUSCLE MENTOR QUESTIONNAIRE

Name*

First NameLast Name
Email*
example@example.com
Sex*

MaleFemale
Age*
Height*
Current Weight (Lbs)*
Goal Weight (Lbs)*
Days per week currently training*
Occupation*
Training Questions
No. of years training experience*
Number of days willing to train per week*
Describe any exercises you love to do
Describe any exercises you dislike
Nutrition Questions
Describe your current diet with as much detail as possible.*
Describe any previous dieting habits you have done in the past (include any habits that worked well or didn't work well).*
Medical Questions
Do you have any pre-existing injuries that affect your ability to exercise?*

YesNo
If answered yes to the question above, detail the injury(ies) here:
Have you ever been diagnosed with high blood pressure?*

YesNo
If answered yes to the question above, are you on any blood pressure regulating medications currently?

YesNo
Do you currently have high blood pressure?*

YesNo
Program Logistics

and pricing
Included in Program

1. Full training regimen provided through the CoachRX application, customized to your training preferences and goals in terms of session frequency and types of exercises.

2. Weekly check-ins emailed to brandenmhales@gmail.com with updated weight and progress pictures (progress pictures will NOT be shared without permission from the client).

3. Twice Monthly In-Depth Analysis (Zoom Call) to catch up and analyze progress and make necessary changes.

4. 24/7 Access via Texting and In-app messaging for questions, comments, or anything that you need help with.

5. Meal Plans/Nutrition coaching provided via email and face-to-face video calls.

Plan Cost

$250/mo.

**ALL SESSION FEES WILL BE PUT AUTO-PAYMENT**
Recurring payments will be totaled as a monthly fee for all features requested.

There is no contract associated with these services and future payments may be cancelled at any time but payments made are non-refundable.
I understand that the monthly fee once paid is non-refundable and that all fees must be on auto-pay, but future payments may be cancelled at any time by the client or trainer.*

Yes
I understand that results come from abiding by the instruction of the trainer, and that I (the client) am responsible for abiding by the instruction provided.*

Yes
Waiver of Liability
I hereby affirm that I am voluntarily starting a course of instruction in physical fitness and performance training (The Activity). I am voluntarily participating in the Activity entirely at my own risk.

In full consideration of the risk of injury while participating in the Activity, and for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily participate in this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any kind of risks related to traveling to and from as well as participating the Activity, which may include, but are not limited to, physical or phycological injury, pain, suffering, illness disfigurement, temporary or permanent disability, economic or emotional loss, and death.

I acknowledge that I have carefully read this form and fully understand that it is a release of liability. I expressly agree to release and discharge the trainer or instructor from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I may otherwise have to bring a legal action for personal injury or property damage.
Sign here acknowledging and accepting the Waiver of Liability above.

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My Products

MUSCLE MENTOR | Online Training and Nutrition

$250.00 for each month

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NEXT STEPS

Start the monthly subscription and schedule your first video call with Branden: 208-585-4837
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Training Questions

Nutrition Questions

Medical Questions

Program Logistics

Waiver of Liability

NEXT STEPS