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© 2023 Meathead Athletics.

Basic Information

Tell us a little about yourself.

in/cm - please label
kg/lbs - please label

Health History

Please answer the following questions.

Has a doctor diagnosed you with a heart condition?
Do you experience sharp pain or extreme tightness in your chest in cold temperatures?
Do you have or have you had diabetes, hypertension, or high blood pressure?
Does anyone in your family have diabetes, hypertension, or high blood pressure?
Have you experienced rapid heartbeat or palpitations?
Have you ever or do you take medications or been on a special diet to lower cholesterol?
Are you overweight?
Are you under excessive stress?
Do you drink?
Do you have a physical condition, impairment, or disability (including a joint or muscle problem) that should be considered before you begin a nutrition program?
Do you have any food allergies or intolerances?
Have you been diagnosed with an eating disorder?

Lifestyle Info and Food Preferences

Just a few more things we need to know.

What is your goal?
Do you have a goal weight?
What's your activity level?
Do you work out?
Do you cook?
What do you like to eat?

Terms and Conditions

I acknowledge that I am aware that Meathead Athletics, its members, officers, agents, employees and independent contractors are not medical doctors and do not diagnose disease. I also acknowledge that I have been warned that I should consult a Physician before undergoing any dietary or food supplement changes.

I also affirmatively state that I have disclosed any and all known medical or genetic conditions, medications I use, and any significant personal or family medical history. Any recommendations that I follow for changes in diet, including but not limited to the use of food supplements, are entirely my choice and my responsibility.

I am knowingly assuming any risk associated with nutritional counseling. In consideration of my participation in nutrition counseling, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release Meathead Athletics, its members, officers, agents, employees and independent contractors from any liability whatsoever to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness, injury or other harm to my person, including my death, that may result from or occur during my participation in nutrition counseling, whether caused by the sole or concurrent negligence of Meathead Athletics, its members, officers, agents, employees and independent contractors.

I further agree to indemnify and hold harmless Meathead Athletics, its members, officers, agents, employees and independent contractors, to the fullest extent permitted under law, from any and all liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in the described nutrition counseling session.

Consent *

Nutrition Coaching Cancellation Terms: A written notice of cancellation is required 30 days before you'd wish to cancel your subscription.
2023 Meathead Athletics ®