Lifestyle Audit & Coaching Application
Online Coaching Program Enrolment
Please select the Online Coaching Package or Lifestyle Marketplace Program/Product you would like to purchase.
For Monthly Coaching Rates & Package Promotions
We respect your privacy.
Tell us more about your daily lifestyle activity!
🛑 ATTENTION 🛑
👉🏼This section is very important and your responses will be the foods we use as the foundation for the design of your Daily Meal Plan.
✅ Please include a detailed list of the current dietary Fats, Carbohydrates, Proteins, Vegetables & Condiments in your current diet.
❗️You may also use this section to declare any Trigger Foods or Strong Dislikes
✋ Please share any dietary restrictions, medically diagnosed allergies or severe food intolerances that will be noted to avoid throughout your program.
If yes, please provide as much detail as you wish as it may pertain to your coaching program. If no, please leave section blank.
If yes, please provide details on your current exercise routine, sporting and/or leisure activities below.
Please provide us with any information on your health history that could impact your ability to begin exercising, dieting & participating in a Life Aesthetics Coaching Program
🏆 This section is for YOU.
✅ Tell us more about how you want to feel at the end of your program and the tangible or intangible results you are ready to work hard to achieve.
✅ Each morning that you wake up what will be your reminder that keeps you inspired, motivated and excited to work hard towards your goals?
❌ Have you experienced any struggles, obstacles or hesitations previously to joining Life Aesthetics?
Progress Photo Submission
❗️ Please upload your (3) initial progress photos (front, side and back) using our secure Photo Submission Form - you will be re-directed after clicking Submit below.
📸 The (3) Photos should taken facing the Front, Side and Back with natural lighting, such as the incoming sun from a window, wearing comfortable attire (ie. sports attire/bikini) that showcases your full body. Hands should remain relaxed by your side or held directly outwards and limited distractions should be behind you or to the side of you that take the focus away from your body in the photo, and don’t forget to SMILE.
LIFE AESTHETICS. LIFE CLIENT LIABILITY RELEASE & REFUND POLICY
Please read the terms below and click accept:
IN CONSIDERATION OF PERMISSION TO USE, TODAY AND ON ALL FUTURE DATES, THE PROPERTY, FACILITIES, AND SERVICES OF LIFE AESTHETICS INC. AND TO PARTICIPATE IN WEIGHT TRAINING, CARDIOVASCULAR TRAINING, AND OTHER PHYSICAL ACTIVITIES, CLIENT, ON BEHALF OF HIMSELF OR HERSELF, HIS OR HER HEIRS, PERSONAL REPRESENTATIVES, AND ASSIGNEES, DOES HEREBY RELEASE, WAIVE, AND DISCHARGE LIFE AESTHETICS INC., EMPLOYEES, VOLUNTEERS, INDEPENDENT CONTRACTORS, OFFICERS AND AGENTS (COLLECTIVELY, THE “RE- LEASED PARTIES”) FROM LIABILITY FROM ANY AND ALL CLAIMS ARISING FROM CLIENT’S OWN NEGLIGENCE, THE NEGLIGENCE OF OTHERS, OR THE RELEASED PARTIES’ NEGLIGENCE ORIGINATING FROM CLIENT’S PARTICIPATION IN ANY PROGRAM. THIS AGREEMENT APPLIES TO: 1) PERSONAL INJURY (INCLUDING DEATH) FROM ACCIDENTS OR ILLNESSES ARISING FROM THE PARTICIPATION IN PHYSICAL ACTIVITIES INCLUDING, BUT NOT LIMITED TO, ORGANIZED ACTIVITIES, CLASSES, OBSERVATION, AND INDIVIDUAL USE OF FACILITIES, PREMISES, OR EQUIPMENT; AND 2) ANY AND ALL CLAIMS RESULTING FROM THE DAMAGE TO, LOSS OF, OR THEFT OF PROPERTY. CLIENT CERTIFIES THAT HE OR SHE KNOWS OF NO MEDICAL PROBLEM (EXCEPT THOSE NOTED HEREIN) THAT WOULD INCREASE HIS OR HER RISK OF ILLNESS AND INJURY AS A RESULT OF PARTICIPATING IN A PHYSICAL TRAINING PROGRAM. CLIENT UNDERSTANDS THAT HE OR SHE HAS BEEN ADVISED TO CONSULT A PHYSICIAN PRIOR TO COMMENCEMENT OF A PHYSICAL TRAINING PROGRAM TO ENSURE HIS OR HER STATE OF WELLNESS TO PARTICIPATE IN SUCH STRENUOUS ACTIVITIES. CLIENT UNDERSTANDS THAT AFTER PAYMENT HAS BEEN RECEIVED AND CONSULTATION SERVICES RENDERED NO REFUNDS WILL BE ISSUED. CLIENT UNDERSTANDS THAT ALL NUTRITIONAL AND SUPPLEMENTATION ADVICE SHOULD BE DISCUSSED WITH A PHYSICIAN PRIOR TO MAKING ANY DIETARY CHANGES THAT MAY RESULT IN ILLNESS. CLIENT UNDERSTANDS THAT LIFE AESTHETICS INC DOES NOT CLAIM TO BE REGISTERED DIETICIANS OR MEMBERS OF ANY PROFESSIONAL BOARD ANY ALL ADVICE REGARDING NUTRITION AND SUPPLEMENTATION SHOULD BE FOLLOWED AT THE DISCRETION OF THE CLIENT. CLIENT AGREES TO INDEMNIFY AND HOLD THE RELEASED PARTIES HARMLESS FOR ANY LOSS CAUSED BY CLIENT FOR WHICH THE RELEASED PARTIES ARE HELD LIABLE INCLUDING ATTORNEY’S FEES AND ARBITRATION COSTS.
Thank-you for submitting your myLifestyle Questionnaire
- Please send your (3) initial progress photos (front, side and back) to firstname.lastname@example.org
If you have any questions please contact us