Login
Forgot Password?
New User
Share on Twitter Share on Twitter Watch on YouTube
 
 
CLIENT PROFILE EVALUATION
Vital Statistics  
Name:
Age:
Birth Date: (mm/dd/yyyy)
Address:
Email:
Phone number:
IM chat name:
IM chat service:
What is your current body weight in the morning?

What is your height?

What is your body comp reading (if you have it)?

What time do you wake up?

What time do you go to sleep?

What do you eat daily (with approx times)?


Please tell me your daily macro nutrient counts if you know them:
Carbs per day:
Protein per day:
Fats per day:
What supplements and or medications are you using currently?

Do you have any food allergies or any aversions to particular foods?

What is does your workout schedule look like each week?

What does your cardio schedule look like each week?

What is your past medical history?

How did you hear about us?
Google ads
Print ads (which one):
Other (please specify):


Are you interested in:
Figure
Bodybuilding
Weight Loss
Bikini Competition

What are your goals for your body?

If you are planning on competing in figure, bikini or bodybuilding, what shows do you want to target or plan for?

We would like to include you in our e-newsletter. We often send these out with monthly specials, contest updates, free recipes and more. Please indicate your preference.
Yes, I would like to receive your e-newsletter
No, I would not like to receive your e-newsletter at this time

You will be expected to email Tad Inoue 3 digital pictures of yourself (front, side and back) for assessment. Additional pictures may be required as your program progresses. Email these program pictures to Tad@TadInoue.com once you have signed up for a program.

I, AGREE TO ALLOW TAD INOUE TO DESIGN A WEIGHT MANAGEMENT PROGRAM FOR ME TO ENHANCE MY HEALTH & FITNESS GOALS. I WILL FOLLOW THAT PROGRAM TO THE BEST OF MY ABILITY AND I WILL NOT HOLD TAD INOUE OR TADTHEDIETCOACH.COM OR ANY RELATED PERSONS OR PARTIES PERSONALLY LIABLE FOR ANY PROBLEMS, ILLNESSES OR INJURIES THAT MIGHT OCCUR DUE TO A SUDDEN CHANGE IN MY EATING HABITS. THIS WEIGHT MANAGEMENT PROGRAM DOES NOT REPLACE THE EXPERT ADVICE OR MEDICAL TREATMENT OF MY OWN PRIVATE DOCTOR. I HAVE GIVEN TAD INOUE AND TADTHEDIETCOACH.COM ALL NECESSARY INFORMATION ABOUT MYSELF TO PREVENT ANY POSSIBLE COMPLICATIONS.

I agree to these terms

Date: (mm/dd/yyyy)

Sellers (Consultant) and Purchasers (Client) Hold Harmless and Indemnification Agreement I, the undersigned ("the Purchasers") hereby warrant that I will indemnify and hold harmless TAD INOUE, known hereafter as ("the Sellers"), and its officers, directors, agents and employees. This indemnification and hold harmless warranty extends to Sellers, individually and separately, and, the corporation's successors, and subsidiaries, as against any and all claims, demands, actions, and causes of action, including personal injury, and all other liability whatsoever, including, but not limited to, costs, attorney's fees and/or judgments which arise out of the use of the any weight management program. The undersigned, as Purchaser(s) further warrant the program is to be utilized within the State(s) of , and it will hold harmless and indemnify the Sellers corporation, its agents, directors, officers, employees and individuals named in paragraph one of this Hold Harmless and Indemnification Agreement, against any and all claims for liability and/or damages, arising from any and all violation(s) of Codes, Statutes, Licensing Procedures, Licensure Examinations and/or Registration Requirements, of such state(s), which govern the practice of dietetics and/or weight management and/or nutritional counseling and/or advise, whether known or unknown to the Purchaser(s) at the time of purchase and subsequent use with the public of any weight management system(s). Such indemnification includes, but is not limited to costs, attorney's fees, and damages, whether or not reduced to judgment and judgments which might arise from such claims, law suits, and/or administrative filings. The indemnification includes all costs and attorney fees incurred by the Sellers in the investigation and defense of any claim enumerated in paragraphs preceding prior to a determination of an exact date of an occurrence and/or incident and/or violation upon which such alleged claims may be based. It is further understood and agreed by the Purchaser(s), that the consideration for this Indemnification and Hold Harmless Agreement, benefiting the Seller, its agents, directors, officers, employees and the individuals named in the paragraphs preceding is the "weight management software content of the program". Signature of Purchaser(s), confirms that Purchaser(s) have agreed to be bound by the terms of the Indemnification and Hold Harmless Agreement and are contractually bound to indemnify the Sellers and its agents, directors, officers, employees and the individuals named in paragraphs preceding, and such obligation includes the responsibility to pay any and all costs and attorney's fees which may be incurred by the Buyer in defending its agents, directors, officers, employees and individuals named in the paragraphs preceding. I also further understand that Tad Inoue will not refund any fees paid for services if I decide to terminate this Agreement or if I decide to discontinue any services from Tad Inoue. I understand that there are no refunds of any fees paid under any circumstances. I further understand that Tad Inoue’s advice and programs are not to be taken in place of medical care and that Tad Inoue is not responsible for the health and wellbeing of any person's he renders dietary coaching to.

Enter the text shown below

 

I agree to these terms

Date: (mm/dd/yyyy)