Thanks for signing up and congratulations on taking the first step to a more healthy you!

Next Steps: Complete the intake forms.

Please complete each of the following forms.

Questionaire

Please choose the time you would like to chat once a week at the same time every week. If it is available I will book you for that time. If its not we will adjust to a different time frame that works for us both. Please note that all plans will start on Monday.
(anaerobic)
(aerobic)
Things that keep you active while having fun...
In ounces
List typical types of food (we may need to retrain the brain)
Hours
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Please note: The asterisk * is multiplication.
Click or drag a file to this area to upload.

Questionaire

Click or drag a file to this area to upload.
Thank you so much for choosing to work with us and letting us be a part of this your transformation. Please attach a short video of your goals desires excitement or anything you feel you would like to say and we will revisit this video at the end to compare your losses gains and sentiments
Please choose the time you would like to chat once a week at the same time every week. If it is available I will book you for that time. If its not we will adjust to a different time frame that works for us both. Please note that all plans will start on Monday.
How many hours a week would you say you are willing & able to dedicate to yourself and this program
which do you belong to?
Do you participate in any online classes? Youtube, Pelaton, Fitness
Please list any fitness or food app tracker you are using.
Please list the hobbies and activities that you will be doing to help me better understand your life style and how to best customize your workout
Please list below how you plan to workout and include the ways you currently train if they are something you would like to keep in your fitness routine.
Please list the boutique fitness gyms you belong to EXAMPLE: solid core, soul cycle, barrys, f45, your local pilaties studio, your local yoga studio
Please list below what your personal fitness goals are
Please list below what your personal health goals are.
What is your resting heart rate
Do you meditate? If so how much?
Please list any supplements (vitamins, minerals, herbs or homeopathic meds) or prescription medication you might be taking.
Are you under the care of any doctor in eastern or western medicine? Please list if you think this would help.
Currently are you undergoing any treatments that you think could affect fitness and weight loss. Additionally are there any treatments that you are doing that may help with weight loss and fitness.
please list all accidents, injuries, diagnoses, surgeries, etc. including the date and diagnosis
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Please note: The asterisk * is multiplication.

Services Agreement

I (herein after known as "CLIENT"), named here below, by submitting this form, agree to everything contained herein.
RECITALS:
WHEREAS CLIENT wishes to retain the professional services and expertise of YOUR BODY BLUEPRINT to design for CLIENT a personalized body management program, which may include one or all of the following: a customized diet, training program which may include weights and/or cardiovascular exercise, supplement schedule, and personal consultation (hereinafter the "SERVICES"); and WHEREAS Laura Sikora YBB Fitness Consultant agrees to provide the SERVICES to CLIENT, in exchange for a fee, in accordance with the following terms and conditions, IT IS HEREBY AGREED AS FOLLOWS:
  1. Retention CLIENT hereby retains LAURA SIKORA, as an independent contractor, to design the SERVICES for CLIENT, including a weight management program, to enhance the health and fitness of CLIENT, and to meet the health and fitness goals of CLIENT.
  2. Due Diligence by Client CLIENT acknowledges that he/she has provided LAURA SIKORA with all background information, including appropriate medical history, which may be necessary to prepare, formulate and perform the SERVICES for CLIENT. CLIENT agrees that he/she shall use his/her best efforts to comply with the diets, programs, schedules and recommendations made by LAURA SIKORA as part of the SERVICES. CLIENT expressly warrants and affirms to LAURA SIKORA that he/she has obtained appropriate medical clearance to participate in the diet, exercise and training programs comprising the SERVICES.
  3. Assumption of Risk/Waiver of Liability CLIENT understands and acknowledges that participation in any diet, exercise and training program carries with it the inherent risk of bodily injury and/or illness. CLIENT agrees that he/she will forever release and hold LAURA SIKORA harmless from and against any and all claims, whether for personal injuries, illness or otherwise, arising from the SERVICES, and that he/she shall not in any way seek to hold LAURA SIKORA liable for any and all such claims.
  4. Not a Substitute for Medical Treatment CLIENT understands and acknowledges that the SERVICES, including the weight management program, are not in any way intended to function as a substitute for medical treatment and/or advice from CLIENT’s own physician.
  5. Confidentiality and Non-Disclosure CLIENT acknowledges and agrees that any and all information disclosed or provided by LAURA SIKORA to CLIENT in connection with the SERVICES is strictly confidential in nature, and constitutes proprietary work product owned by LAURA SIKORA. The SERVICES shall be utilized by CLIENT for the sole purpose of the weight management program and will not be disclosed, or permitted to be disclosed via the internet in any manner, INCLUDING FORUM JOURNALS, WEB BLOGS, PERSONAL WEBSITES OR COMMERCIAL WEBSITES, through literary publication, or otherwise, to any person or entity except as otherwise set forth herein. CLIENT acknowledges and agrees that he/she shall forever maintain as confidential, and that he/she shall not disclose to any third party (other than to a treating physician of CLIENT), any of the information, schedules, diets, recommendations and/or details concerning the SERVICES. CLIENT acknowledges and agrees that his/her duty of confidentiality and non-disclosure pursuant to this Agreement shall survive completion, cancellation, termination or cessation of the SERVICES. CLIENT acknowledges that he/she shall not knowingly or carelessly disclose, cause to be disclosed, or assist in disclosing or otherwise using or disseminating any information disclosed or provided by LAURA SIKORA to CLIENT in connection with the SERVICES. CLIENT acknowledges and agrees to take reasonable measures to prevent unauthorized persons or entities from having access to, obtaining or being furnished with, the information and details comprising or related to the SERVICES.
  6. Immediate Right to Terminate Services CLIENT acknowledges and agrees that LAURA SIKORA shall be entitled to immediately cease and terminate the SERVICES, without notice, in the event CLIENT discloses, or causes to be disclosed, to any third person or entity any information or details comprising or concerning the SERVICES, and in such event LAURA SIKORA shall be entitled to retain any and all remaining funds paid by CLIENT in consideration for the SERVICES, and LAURA SIKORA shall also be entitled to seek appropriate legal recourse against CLIENT.
  7. PAYMENT information: All amounts paid are non refundable except as specifically stated here. All fees are due and payable in advance of given plan and service’s rendered. 50% refund is refundable only for services rendered between date of payment and 90days. Said given custom plan is not refundable at anytime once shared.
  8. Indemnity for Breach of Agreement CLIENT agrees to indemnify and hold harmless LAURA SIKORA for any and all losses, claims, damages, attorney’s fees, judgments or liability arising from CLIENT’s breach of this Agreement.
  9. Binding Arbitration CLIENT acknowledges and agrees that any controversy or claim arising out of or relating to this Agreement or the breach thereof shall be resolved by binding arbitration in the State of California, utilizing the substantive and procedural laws of the State of California, in accordance with the rules and procedures of the American Arbitration Association. The Parties shall be entitled to such discovery as shall be determined by the arbitrator(s). Judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof.
  10. No Unwritten Waiver Effective No waiver of any breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the Party waiving the breach, failure, right or remedy. No waiver of any breach, failure, right or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies.
  11. Severability If a court or an arbitrator of competent jurisdiction holds any provision of this Agreement to be illegal, unenforceable, or invalid in whole or in part for any reason, the validity and enforceability of the remaining provisions, or portions of them, will not be affected, unless an essential purpose of this Agreement would be defeated by the loss of the illegal unenforceable or invalid provision.
  12. LAURA SIKORA and Independent Contractor With regard to performance of the SERVICES and all matters referenced in this Agreement, LAURA SIKORA shall at all times be an independent contractor. Nothing in this Agreement, or any actions taken pursuant to this Agreement, shall be deemed to create any express or implied employment or agency relationship between CLIENT and LAURA SIKORA. Neither party to this Agreement shall have the authority to legally bind the other, except as otherwise set forth herein.
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Please note: The asterisk * is multiplication.

Guidelines

  1. Upon the receipt of the necessary information from the client, the client will contact your consultant at YOUR BODY BLUEPRINT to set up an initial consultation and all follow-up appointments. This will be the times in which we will review and prepare for the outline of your program and all the weeks that it includes.
  2. Client shall email digital photos (front, back & both sides) directly to your consultant [email protected] Women should dress in any 2 piece swimsuit. Men can wear bike shorts or gym shorts and no shirt.
  3. During your appointment call times on Monday (weekly or bi-weekly) your consultant will make the necessary changes to your diet and/or exercise program to ensure your continued progress. These calls will be 15 minutes
  4. For scheduled appointments please call your consultant at (559)859-6339
  5. It is imperative for the success of your program that the client follows all changes and advice from your consultant and not allow themselves to be swayed by outside sources. While we respect each individual's right to his/her own opinion, your consultant does not want anything to interfere with achieving the best fitness results for their clients.
  6. There is no refund on this program once it has been written, prepared and received by the client.
  7. A 24-hour notice is required to reschedule any appointments with your consultant.
EVERY ACCOMPLISHMENT STARTS WITH THE DECISION TO TRY

THANK YOU FOR LETTING ME HELP YOU ACHIEVE SUCCESS
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Appointments

To all my valued clients,


Your appointment time is important to me and to your program. This is the time we will discuss all the necessary steps to take moving forward and answer any questions you may have. It is important to be on time for your calls as this is a small window of time and don’t want that to jeopardize the time I have with you.


Please provide a 24hr cancellation or rescheduling notice if needed. You may contact 310-896-8117 via text or call to do so.


Contact # (559)-859-6339


I enjoy speaking with each of you and value our time to be able to share information that will allow you to be successful on your program. It is also very important not to miss any appointments as it may be difficult to reschedule. If you know in advance that you cannot make your appointment please let us know as soon as possible, and we will reschedule immediately for the soonest available.


Thank you so much for your consideration with this matter and I am looking forward to all of our future appointments.

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Please note: The asterisk * is multiplication.

Disclaimer

Before beginning with your Fitness Consultant, please read the following information carefully, check the acknowledgment box and submit the form.

FITNESS GOALS

The fundamental goal is to encourage people to become knowledgeable about—and responsible for—their own health. YOUR BODY BLUEPRINT helps individuals reach their optimal level of overall Health & Fitness by supporting and bringing balance to the foundations listed below. All are designed specifically for you and your body's needs. Comprised of these necessary tools.

  1. Food
  2. Supplements
  3. Cardio
  4. Weights

By supporting yourself with the combination of each of these foundations you can change the body's chemistry and be brought back into balance, setting the stage for optimal health and fitness transformation.

This is not designed, however, to treat any specific disease or medical condition. Your Fitness Consulting is here to make recommendations of dietary change and nutritional supplements, not medical diagnoses or prescriptions. No comment or recommendation from your Fitness Consultant should be construed as a medical diagnosis or prescription.

Reaching optimal health & fitness requires sincere commitment, possible lifestyle changes, and a positive attitude. If you are not willing to change how you eat and live, Fitness Consulting is not the right approach for you. Since every human being is unique on a biochemical level, we cannot guarantee any specific results from our programs.

HEALTH CONCERNS

If you suffer from a medical or pathological condition, you need to consult with the appropriate healthcare provider. Your Fitness Consultant is not a substitute for your family physician or other appropriate healthcare providers. A Fitness Consultant is not trained nor licensed to diagnose or treat pathological conditions, illnesses, injuries, or diseases or prescribe medications.

If you are under the care of another healthcare provider, it is important that you contact your other healthcare providers and alert them to your use of nutritional supplements.

Fitness Consulting may be a beneficial adjunct to more traditional care, and it may also alter your need for medication, so it is important that you always keep your physician informed of changes in your nutritional program.

If you are using medications of any kind, you are required to alert your Fitness Consultant to such use, as well as to discuss any potential interactions between medications and nutritional products with your pharmacist. If you have any physical or emotional reaction to your body blueprint program, stop immediately and consult your physician. Contact your Fitness Consultant to ascertain if the reaction is adverse or an indication of the natural course of the body's adjustment to the therapy.

COMMUNICATE

Every client is a biochemical individual, and it is not possible to determine in advance how your body will react to the whole program including your heart rate training, weight lifting and supplementation you need. It is sometimes necessary to adjust your program as we proceed until your body can begin to properly accept targeted nutrients geared to correct enhance proper healing through the night, potential deficiencies, ad help with energy stabilization. Along with your fitness routine, It is your responsibility to do your part by:

  1. Following the nutrition guidelines provided
  2. Taking supplements as directed (unless otherwise specified by your general physician)
  3. Avoid harmful foods, substances & behavior
  4. Moving your body
  5. Get adequate rest
  6. Stay in contact with your Consultant so they can stay informed of your progress and provide the best course of action going forward.

Note that a Fitness Consultant does not diagnose or treat disease, but instead makes nutritional recommendations for balancing the body and promotes optimal wellness in accordance with the right routine via fitness to show the results your desire. YOUR BODY BLUEPRINT - Fitness Consulting is my own brand developed from my love and commitment you achieve your goals, not licensed or certified by any state.

CLIENT PRIVACY POLICY

During the course of Fitness Consulting, your Consultant will ask that you provide relevant personal details and information relating to your background, health, lifestyle, etc. (hereafter referred to as “Information”), including but not limited to:

  • Your name, height, weight, health history, including injuries, surgeries, etc.

This information will be gathered from you via in-person interviews, questionnaires, evaluations, intake documents, phone, email, mail, video conferences, etc. whatever is necessary and used to:

  • Help assess your nutritional & fitness needs.
  • Make recommendations for dietary changes and nutritional supplements to support your specific fitness goals.

To ensure the maximum benefit of Fitness Consulting it is important that your Information is accurate and up-to-date. If you notice any changes to your health, begin taking new prescriptions, etc., please notify your Consultant as soon as possible. It is also your right as a client to access, update, or delete your records at any time. To do so, simply notify your Consultant in writing. Your Consultant will retain your Information for the length of time you are a client, after which they will take reasonable steps to dispose of your Information in a secure fashion.

What is 7+4?

Photo Release

We are very excited about our clients and future clients results. Our soon to be success stories are extremely motivated by seeing the success demonstrated in our testimonials & before and after gallery. We appreciate all of our clients who have given us permission to use their before and after photos on our website. This helps encourage others to share in the same success!

If you would be willing to allow us to share YOUR SUCCESS STORY using your photos please acknowledge by checking the box below.

Thank you!
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Please note: The asterisk * is multiplication.
Click or drag a file to this area to upload.

Food Journal

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Values determine how you answer this question. Our core values highlight what we stand for. Values guide our behaviors, decisions, and action. When you know what you value, you can live in accord with those values. This leads to fulfillment. When you don't know your values, you violate them daily. This creates internal tension and tension triggers destructive habits and regressive behavior.
These are here for us to look back on once we go through your values in depth. We will then cross compare.
Consider a meaningful moment, a peak experience that stands out to you. What was happening to you? What was going on? What values were you honoring at this time?
Now, go in the opposite direction. Consider a time when you got angry, frustrated, or upset. What was going on? What were you feeling? now flip those feelings around. What value was being suppressed?
What is most important to you in your life? beyond basic human needs, what must you have in your life to experience fulfillment? Creative self-expression? A strong level of healthy vitality? A sense of excitement and adventure? Surrounded by beauty? Always learning? What are the personal values you must honor or a part of you withers?
Combining all the answers from above you now have a master list of personal values. If there are 20-40 values on your list, that is to many to be actionable. Please group these values under related themes. Values like accountability, responsibility, and timeliness are all related. Values like learning, growth, and development relate to each other. Connection, belonging and intimacy are also related.
If you have a group of values that include honesty, transparency, integrity, candor, directness, and truth, select a word that best represents that group. For example, integrity might work as a central theme for the values I listed.
Now comes the hard part. You may still have a sizable list of values. Here are a few questions to help you whittle your list. What values are essential to your life? What value represents your primary way of being? What values are essential to supporting your inner self. The magic range is 5-10 values. Too few and you wont capture all the unique dimensions of your being and too many you'll forget them or wont take advantage of them. Rank them in order of importance. This is often the most challenging part.
Now creativity comes into play. Highlight values into memorable phrases or sentences helps you articulate the meaning behind each value. This give you the opportunity to make the value more emotional and memorable. For example: lets say you have identified a core value of health to represent other values, like energy and vitality. You values statement might be: "health: to live with full vitality and energy everyday"
Once you've completed your list of core values, walk away from them and revisit them the next day after a good nights sleep. How do they make you feel? Do you feel they are consistent with who you are? Are they personal to you? Do you see any values that feel inconsistent with your identity? Check your priority ranking, are they in oder of importance?
Are you living your personal values? Remember nothing is final and this may change for you in the months and years to come. it is important to stay on top of it. My suggestion is to revisit this annually. From a centered position, assess how well you are honoring each value by scoring each one on a scale of 1-10. 10 represents optimal living through the value. What is your level of satisfaction? Record your score for each. You can set up a table in YOUR BODY BLUEPRINT google drive sheet. Date the top of the column and repeat this monthly or quarterly to assess your progress. If your score is 7 in a particular value, what changes do you need to make? What has to happen for you to further honor this value? Please take notes in the above box about where you feel you are at and at what # ranking. THIS PROCESS WILL BRING A NEW LEVEL OF CLARITY TO YOUR DECISION MAKING PROCESS. ENJOY
WE WILL SEND YOU A DISCOUNT CODE FOR YOU TO USE ON ANY FUTURE PROGRAMS.
PLEASE SHARE A FRIENDS EMAIL WITH US THAT YOU THINK WOULD BE LIKELY TO BENEFIT FROM YOUR BODY BLUEPRINT. AND WE WILL SEND YOU AND YOUR FRIEND A DISCOUNT CODE. ALSO RECEIVE DISCOUNTS FROM FRIENDS THAT SIGN UP.

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