Questionnaire
Personal Info
Name
*
First Name
Last Name
DOB
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Medical History & Injuries
Do you have any pre-existing medical conditions that might affect your nutrition and / or fitness, or ability to follow a fitness and/or diet programme?
*
Do you have any injuries that affect training in any way?
*
Have you had any recent surgeries?
*
Terms of Service - PLEASE READ CAREFULLY
None Refundable
Refunds are generally not provided, however exceptional cases at the sole descretion of Sam may be considered. Requests must be made directly to Sam for review.
Full Liability Waiver
You agree to release any liability from Sam for any loss, damage or injury that may occur whilst receiving the services. You understand that participating in any activity or service provided by Sam involved some risks and accept full responsibility for your safety and well-being.
Information Sharing Restricted
You agree not to share, distribute, or disclose any confidential information obtained through interactions with Sam, except as mututally agreed in writing. Unauthorised sharing of such information will be directly addressed by Sam.
Disclaimer
Sam Hinks is not a licensed medical professional or dietician or physiotherapist. The information provided in any of his communication should not be construed as medical or nutritional advice and should not be used for the diagnosis, treatment, cure, or prevention of any health condition or injury. It is not a substitute for professional medical guidance from a qualified healthcare provider or nutrition advice from a qualified dietician. Please consult with your physician or a qualified healthcare professional regarding any health concerns and a qualified dietician for safe and appropriate diet advice. Any injuries a licensed physiotherapist should be consulted with. The content of all coaching communications with Sam on any platform is confidential and any advice shared is hypothetical. In particular Sam Hinks and anyone associated with his coaching company does not encourage or condone the use of illegal performance enhancing substances and any advice shared is from a hypothetical standpoint. The use of these substances including but not limited to anabolic steroids, peptides, nootropics, metabolic modulators, diuretics, amphetamines including, legal, illegal substances and misuse of prescription medications can lead to serious life altering illness, injury and death. As such the use of any or similar substances is a personal choice and neither Sam Hinks nor his coaching company will be liable for and consequences of taking these or similar substances. This plan is designed to support your health, performance and body composition goals It is not intendedd to replace medical advice or override any recommendations made by your healthcare provider. If you're managing a currect health condition, you must make Sam Hinks aware of this and continue to monitor your condition as before. For example, if you're diabetic (type 1 or insulin dependant type 2), you must continue to monitor your blood glucose levels as advised by your healtcare provider. Adjust insulin doses according to your personal carb rations, correction factors and individual needs. Seek advise from your diabetes care teams before makign any significant changes to your nutrition, supplementation or training. Whilst I will work with you in your condition, and take guidance from you & your health team on your personal symptoms etc. You understand this plan is not intended to diagnose, treat or cure any medical condition. You acknowledge that the management of your condition remains your responsibility and you should always refer back to your medical team.
Cooling-Off Period Waiver
Under the Consumer Contracts Regulations 2013, clients normally have the right to cancel a purchase within 14 days. By signing this agreement, you explicitly request that coaching services begin immediately. You acknowledge that coaching services may include the delivery of personalised plans, digital programmes, educational materials and coaching support. By requesting that services begin within the 14-day cancellation period, you acknowledge and agree that you waive your right to cancel once coaching services have begun or digital materials have been delivered.
Please sign to show you understand & accept the above terms
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