Intake Form Logo
  • Intake Form

    Please review and sign
  • Health Background

    Medical History
  • Lifestyle

  • Goals and Expectations

  • Terms and Disclaimer

    Please read and agree to the following terms.
  • The recommendations of Eiseman Coaching Group, LLC are not a substitute for medical advice, diagnosis or treatment, nor is the information provided herein intended to replace consultation with a qualified physician or other healthcare providers. Use of these services shall not constitute the establishment of a physician/patient or clinical relationship with any individual. Please consult your physician before beginning any new diet program or plan.


    Not Medical Advice
    NutritarianLiving.com and Eiseman Coaching Group, LLC emphasizes that their services do not constitute medical advice or replace care from licensed healthcare professionals. I am not a medical professional. As a nutrition coach, I am not providing healthcare, medical, or nutritional therapy services or attempting to diagnose, treat, prevent, or cure any physical, mental, or emotional issues.

    Consult a Physician
    You will always seek advice from your physician or other qualified healthcare provider before undertaking a new health regimen.

    Assumption of Risk
    You recognize that any activity in which problems/life situations are discussed bears some risk, which I the Client agree to accept in its entirety.

    Release of Liability
    You expressly agree to release and discharge Eiseman Coaching Group, LLC from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against Eiseman Coaching Group, LLC for personal injury or property damage.

    Personal Responsibility
    You acknowledge that you are participating voluntarily in using our website or blog or in any of our e-mails, programs, services, and/or products, and you alone are solely and personally responsible for the results.

    No Guarantees
    Eiseman Coaching Group, LLC cannot and does not guarantee that you will attain a particular result, and you understand that results differ by each individual.

    Confidentiality
    All information discussed in our sessions remains confidential.

  •  - -
  • Powered by Jotform SignClear
  • Should be Empty: