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Nutritional Consultation Agreement

This agreement is entered into between the Client (the purchaser/user) who has signed below and Jason Kozma, personal trainer ( Trainer ).

General: This agreement concerns recommendation of an individualized dietary program to clientele.

Fees: Client agrees to pay an initial fee for a dietary consultation as designated below:

Initial Down Payment:

  1. Nutritional program with monitoring - $150
  2. Nutritional program without monitoring - $100

The client (you) will show the diet to my doctor if necessary (see physician approval below), and will not start the diet until my doctor has approved it.

  1. The client will follow the diet provided to me by Trainer exactly as instructed.
  2. The client understand that I must not skip any meals, and must weigh all portions.
  3. The client will honestly record what I eat on a daily basis in the weekly diet dairy, so that Trainer can adjust my diet as necessary. ( only for Nutritional program with monitoring )

Health Statement: (Assumption of Risk). Client understands that this service is designed and intended for persons in good health with no aggravating medical or physical problems. Client has provided a separate statement of medical history to Trainer as a means of assuring Trainer that no such problems exist, which could cause difficulty or complication in this program. Trainer has relied on Client's statement as being accurate and complete, as a condition for entering into this Agreement. As with any diet program, it is recommended that you consult with your physician before beginning the diet program.

Dietary recommendations: Trainer's dietary recommendations are not intended to diagnose, treat, cure, or prevent any disease. The trainer is not nor purports to be a doctor, nutritionist, or any sort of health care professional. Trainer's dietary recommendations are intended to help the client reach his/her program goals as expressed to the trainer by the client. Dietary recommendations are designed and intended for persons in good health with no aggravating medical or physical problems. Client therefore accepts dietary recommendations at their own risk.

Age: Client declares that he/she is over eighteen years of age.

Disputes: Any disputes connected with this Agreement, its execution, or its interpretation shall be settled by mandatory binding arbitration under the Commercial Arbitration Rules of the American Arbitration Association, at Los Angeles, California; using a single arbitrator, with the arbitrator's decision entered into as a judgment in any court of competent jurisdiction. The arbitrator shall award attorney fees and costs to the prevailing party if it is equitable to in the arbitrator's opinion and sole discretion.

Cancellation and Policy Agreement: You, the buyer may cancel this agreement at any time prior to midnight of the third business day, after the date of this agreement, excluding Sundays and holidays. To cancel this agreement, mail or email a signed and dated notice that you are canceling this agreement. A telephone call is also acceptable. If you cancel under these provisions, you are liable for the pro rate costs of any services you have elected to receive prior to the cancellation, plus the cost of informational products purchased and received which you have elected to receive and actually received prior to cancellation, and such amount will be deducted from any refund due to you. You, the client may only cancel thereafter due to medical reason with written consent of your physician stating the reason as to why you are unable to use Trainer's services.

Important information for new clients:

Physician approval: If you are under the regular care of a physician for any specific health condition ( including, but not limited to: high blood pressure, seizures, allergy treatments, asthma, psychotic episodes, etc.) you must show the diet and/or supplement recommendations to your doctor and only proceed with his/her approval.

Monitoring:  If you have selected the nutritional program with weekly monitoring, it is your responsibility as the client to email me weekly - I cannot initiate contact.  Make sure you record everything you have eaten honestly along with any problems you are having on the diet.  Understand that most diets are very strict, and you must adhere 100% to the diet in order to get the desired results.

Thank You

Your consideration in the above matters can ensure that your program is an enjoyable and rewarding experience.


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