Medical Questionnaire and Consent Form

Do you have any allergies? *
Are you taking any medications, over the counter or prescribed? *
Have you a previous medical history? *
Consent I am employing new3fit for a nutrition program, I accept that the New3Fit program is to support my fitness goals within my own control. I understand that new3fit give nutrition advice they do not prescribe treatment or give any medical advice whatsoever. New3Fit will keep all your documents strictly confidential and in a secure location. I accept that it is my responsibility and decision to follow or leave the nutrition program. I agree to hold new3fit harmless for claims or damages in connection with our work together. I understand that this consent form is also a release of potential liability. I accept that the advice under this program is not a guarantee for reaching my fitness goals. I am responsible for seeking medical advice where appropriate. I understand I am free to leave the program at any time I wish. I understand the intellectual property rights and privacy of all the materials and information provided to me during this program. I will not share, copy, or distribute my plan to third parties. I am aware that if I choose to stop following my program I am not entitled to a refund as I have already received the program
Signature
Enter your name and todays date as a digital signature.
Name
Name
Date
Date