Personalized Coaching & Consulting

Full Name*

First NameLast Name

Date of Application

MonthDayYear

E-mail*

Confirmation Email

Country of Residence*

Street Address

Street Address Line 2

Country

How Did You Hear About Us?*

Birth Date

MonthDayYear

Age

What is the primary goal you wish to achieve with our assistance?*

What is your long-term goal that you wish to achieve with our coaching assistance?*

Any Other Goals?

Do an unnasisted pull-up, have a six pack, etc.

Biological Sex*

Measurement Units*

Please use the same measurements units for weight and height.

Current Weight*

If using imperial use pounds; if metric, kilograms

Current Height*

If using imperial, ONLY use inches; if metric, centimeters

Do You Know Your Body Fat Percentage (BF%)?*

What is Your Body Fat Percentage (BF%)

What Method Did You Use to Determine Body Fat Percentage (BF%)?

Note that this measure needs to be not longer than one month old. A DEXA or BodPod measure of +2 months will not be valid.

Please measure your body with a measuring tape as to help us determine your Body Fat %

PLEASE USE THE SAME MEASUREMENT UNIT AS YOU SUPLIED YOUR HEIGHT AND WEIGHT:

Metric: Kilos, cm

Imperial: Pounds, inches

All measurements should be around your naked body, "a circle" - semi tight, but not so much -the tape has to be horizontally straight. Use this guide as reference:

HOW TO MEASURE WITH A MEASURING TAPE VIDEO GUIDE

Neck (at Narrowest)*

Waist (at Navel)*

Waist (at Narrowest)*

Hip (at Widest)*

What Do You Do For Work?*

Exercise or training does not account for energy estimates.

How Many Hours Of Sleep Do You Get Per Night?*

Do You Awaken Rested?*

Important Medical/Health Conditions or Concerns

Are You On Any Medications?

Please write the names and dosages (if known) of medications you are using.

Do you have any particular Medical / Nutrition related concern you want us to review in more depth?

Please write the names and dosages (if known) of medications you are using.

IMPORTANT:

Within the important medical conditions mentioned, the "Long QT Syndrome" was named:

Long QT syndrome (LQTS) is a structural abnormality in the heart's potassium and sodium channels, which predisposes people to tachycardia (arrhythmia). It can lead to loss of consciousness and cardiac arrest even death in young people.

This is one of the few conditions where it is NOT advisable to follow a ketogenic diet (Keto), and even more without medical supervision.

Please consult with your Doctor first.

Do you Currently Track Calories/Macros?*

Please write how many grams of Protein; Carbs and Fat you eat according to your current diet

Protein

NET Carbs (Total - Fiber)

Fat

How Many Meals a Day Do You Currently Eat?*

Include Snacks and Pre/Post Workout Shakes

Are You Currently Following Any Specific Diet?*

What Is the Best Descriptor of Your Current Diet?*

For How Long Have You Eaten This Way?

Any Specific Foods You Do Not Eat?

Please be thorough and explain if your preferences are due moral, religious or other factors.

Do You Have Any Diagnosed Allergies or Food Sensitivities?*

Have You Been Diagnosed With Any GI Condition?*

Are You Using Any Supplements / Vitamins? Performance-Enhancing Drugs, SARMS or Peptides?

Please Name Brands and Dosages

Please Rate Your Experience with Training*

Do You Currently Exercise Regularly?*

Please Describe Your Current Training Regimen

Name of Routine, Sets / Reps, etc.

Where Would You Be Able to Train?*

Home GymFully Equipped GymCrossfit BOXOther

What Equipment Do You Have Access To?*

Days Per Week You Are Able to Train

Any Exercises You Are Unable to Do?

Also, explain why.

Any Pre-existing Injuries or Problems?

Additional Comments or Anything We Need to Be Aware Of?

Please ask here any questions you have that you want me to go in depth, before the start of the coaching, or any important info the coach may need to know.

We will OPTIONALLY need pictures to document and evaluate your progress, as well as to correctly recommend your macros.

Fron, Side, Back whole body pictures (in bathing suit) and in front of a white background are best.

To add a pictures, the best way to do so is via Google Drive.

Here is a walktrough on how to do so:

Upload a file and share it via Google Drive

Then, copy your links below.

Front

Side

Back

Declaration, Disclaimer & Personal Training Agreement
This Agreement is made between KETOGAINS (“Trainer”) and the undersigned Client.

1. Educational Nature of Services
Client understands that all fitness and nutrition services provided are educational in nature and are not medical or psychological services.

Trainer does not diagnose, treat, cure, or prevent any disease. Nothing provided should be considered medical advice or a substitute for consultation with a qualified healthcare professional.

Client has been advised to consult with a physician before beginning any exercise or nutrition program.

2. Medical Responsibility
Client affirms that:

They are physically able to participate in strength, flexibility, and aerobic training.
They are over eighteen (18) years of age.
They have either obtained medical clearance or voluntarily chosen to participate without physician approval.
They have fully disclosed all known medical conditions, injuries, and medications.
Client agrees to inform Trainer of any changes in medical status.

Trainer reserves the right to discontinue services if participation presents a health or safety risk.

3. Assumption of Risk & Release of Liability
Client understands that exercise and dietary changes involve inherent risks, including but not limited to injury, illness, abnormal blood pressure, fainting, heart attack, or death.

Client voluntarily assumes all risks associated with participation and releases Trainer, its agents, representatives, and affiliates from any and all claims arising from participation in the program, including use of equipment or facilities.

4. No Guarantee of Results
Results vary based on individual factors including adherence, body composition, nutrition, lifestyle, and physiology. No guarantees of specific outcomes are made.

5. Services & Payment
Services may include personalized macronutrient recommendations, supplement suggestions, and strength/hypertrophy programming.

Full payment is required prior to services.
Client must initiate consultation within fifteen (15) days of purchase.
Trainer will deliver the program within fifteen (15) business days after receiving all required information and payment.
For fixed-start programs (e.g., Bootcamp), plans are delivered the weekend before the official start date.
Consultation access and communication will be provided as agreed upon in advance.

6. Cancellation & Refund Policy
Client may cancel within three (3) calendar days of signing this Agreement only if services have not yet been delivered.
A $89 USD cancellation fee applies if a refund is requested before program delivery.
No refunds or transfers are permitted once the program has been delivered or consultation has begun.
Purchased consultation time must be used consecutively and may not be paused or frozen.

7. Intellectual Property
All materials provided are copyrighted and may not be reproduced, distributed, or shared without written permission.

8. Confidentiality
Client information will be kept confidential and not shared without consent, except as required by law.

9. Entire Agreement
This document constitutes the entire Agreement between the parties. No other representations or warranties apply.

By signing below, Client acknowledges that they have read, understood, and voluntarily agree to all terms stated above.

Date of Signature*

MonthDayYear

BASIC INFORMATION

Information About You

ABOUT YOUR HEALTH

ABOUT YOUR DIET

ABOUT YOUR TRAINING

INITIAL PROGRESS PICTURES

INFORMED CONSENT AGREEMENT AND RELEASE