Nutrition Coaching Intake Form

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    Nutrition Programs

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    Medical history

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    Developing your Nutrition Program

    Our Coaching Relationship

    Acknowledgment, Participant Release & Cancelation Policy

    I understand and agree that it is my responsibility to inform Fit With Lou of any condition or changes in my health which might affect my ability to exercise safely.

    I agree that Fit With Lou shall not be liable or responsible for any injuries to me resulting from my participation in the nutrition program and I expressly release and discharge Fit With Lou from all claims, actions or judgments as a result of any injury or damage which may occur in connection with my participation in the program.

    I understand that Fit With Lou operates on a scheduled hourly appointment basis and that I must provide a minimum of 24 hours’ notice if I need to reschedule an appointment. The ability to reschedule depends on remaining availability of sessions in the following 7-day period after the cancelled session. Where less than 24 hours’ notice is given, rescheduling is at the discretion of the trainer. Where not possible, I understand I will be charged for the appointment and that my trainer will utilize that time to further develop my training or nutrition plan.

    By signing below, I confirm that all information is true and correct to the best of my knowledge and that I have read and signed the participant release and cancellation policy.


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