ASSESMENT FORM

This is an evaluation form, it is designed to assess the symptoms that may relate to Nutritional imbalance & an unhealthy lifestyle. Its purpose is to educate and inform the individual. It is not designed to diagnose disease, if you suspect you have a problem that requires the attention of a medical practitioner, please see your Doctor for medical care. Ryan Rosier is not a doctor or registered dietitian.

The contents/info you receive should not be taken as medical advice. By participating in RCT’s approach to nutrition, fitness and overall wellness, you are agreeing to accept full responsibility for your actions. All contents/info included or exchanged between RCT and the Client are that of Ryan Rosier and not to be copied, sold, or redistributed. As with any exercise program, you assume certain risks to your health and safety, any form of exercise can cause injuries if the exercises are performed incorrectly, and at New Life Style there is no exception.

This program is a powerful tool, but it’s important to know that you are the driver of your results. Your dedication, along with your personal genetics and history, will influence your rate of progress toward fat loss, muscle gain, and definition. Our priority is creating sustainable, long-term success. As Ryan learns more about how you respond, he will continuously refine your plan to make it more efficient. This means your results will not only become more visible but will also accelerate, all within a safe and healthy framework.

ASSESMENT FORM

If there is anything you don’t know, just leave it blank
Do you stay alone:
Can you walk around in the streets or to the park, beach in your area:
Do you like your occupation:
Please choose (tick) the type of Coaching you are interested in:
Definition: In-person coaching involves face-to-face sessions between the trainer and the client, held at a gym or other physical location. Positives: - Provides direct supervision and immediate feedback. - Builds a stronger personal connection and accountability. - Allows for hands-on adjustments and demonstrations. Negatives: - Requires travel and scheduling flexibility.
Definition: Hybrid coaching combines in-person sessions with online elements, offering flexibility and a blend of both personal and digital support. Positives: - Balances personal interaction with the convenience of online guidance. - Offers flexibility in scheduling workouts and training. - Can be cost-effective by reducing the number of in-person sessions. Negatives: - Requires self-discipline for the online components. - Needs effective communication to coordinate both online and offline elements.
Definition: Online coaching is conducted entirely through digital platforms, using tools like video calls, apps, and emails to deliver training programs and support. Positives: - Highly flexible and can be done from anywhere. - Generally more affordable than in-person coaching. - Access to a broader range of trainers and programs. Negatives: - Lacks direct physical interaction and immediate feedback. - Requires strong self-motivation and discipline. - Relies on technology These options provide a range of training opportunities to suit different preferences and lifestyles.
Every one is welcome at ROSI3R Coaching Techniques Choose the level that lines with your Personality and Goals
Welcome to Level 1—your simple, science-backed starting point! Based on *Precision Nutrition principles*, this approach is easy to follow, effective for 85% of people, and way better than the average diet. ✅ Perfect if you're new to structured nutrition: even if you're already fit! ✅ Great for general wellness: more energy, better mood, and steady progress. ✅ Works for most body types: while customization helps later, this "one-size-fits-most" plan gets results. No complicated tracking—just *smart, sustainable habits* to build a strong foundation. Let’s get started!
Ready to fine-tune your diet? Level 2 is where we tailor your nutrition to *your body, workouts, and ambitions*. Custom macronutrient plans (carbs, protein, fats—optimized for YOU) Carb/calorie cycling fuel smarter for performance) Precision workout nutrition (maximize recovery & results) Ideal for: ✔ Fitness enthusiasts & athletes who want next-level results ✔ Data lovers who track, tweak, and thrive** on details (spreadsheet fans, we see you!) ✔ Anyone chasing specific body comp or performance goals** If you’re ready to *geek out on nutrition*, this is your zone!
Warning: This is advanced stuff! Level 3 is only for experienced athletes with ultra-specific, aggressive goals, like: Bodybuilding competitions Single-digit body fat (for a short period) Peak performance optimization Requires: ✔ 95%+ consistency (this is a skill, not just willpower!) ✔ Rigorous tracking (calories, macros, timing—everything) ✔ Temporary use only (not a lifestyle—just for competition prep or brief phases) For 99% of people, this isn’t necessary—and can even backfire!** We only recommend it for *elite athletes* with a clear, short-term need. Bottom Line: Start at Level 1 - master the basics. Progress to Level 2 - if you want precision. Consider Level 3 - ONLY if you’re competing or pursuing extreme goals. Your success starts where YOU are—let’s build smart!

Medical History
Note: If you have answered yes to any of below questions, you should consult your physician or other appropriate health care provider before engaging in any exercise as you may need to use a facility with a medically qualified staff NOTE: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the seven questions.

PARQ
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Is your doctor prescribing drugs (for example, water pills) for your blood pressure or heart condition?
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change inyour physical activity?
Do you feel pain in your chest when you do physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
In the past month, have you had chest pain when you were not doing physical activity?
Do you know of any other reason why you should not do physical activity?

RSQ
I have been diagnosed with a heart condition Yes/No
I currently have a heart condition
I experience chest discomfort when exercising
I experience unreasonable breathlessness
I experience dizziness, fainting or blackouts
I am currently Diabetic
I have cystic fibrosis
I have asthma or any other lung illness
I get burning sensations in my legs when walking short distances
I have musculoskeletal problems that limit my physical activity
I take prescription medication
I am currently Pregnant

RFQ
I am a male, older than 45 years old
I am a female older than 55 years old, postmenopausal or have had a hysterectomy
I currently smoke or have quit within the last 6 months
I have been diagnosed with high blood pressure, or have been given prescription medication for hypertension
I am uncertain of my blood pressure
I have been diagnosed with high cholesterol, or been given treatment for hyper cholesterolemia
I am uncertain of my cholesterol levels
I have had a close blood relative have a heart attack (mother, sister under 65 years old, father or brother under 55 years old)
I am currently not getting more than 30 minutes of physical activity 3 or more times per week

Blood Type

Nutrition
Do you eat protein 3x a day?
Do you eat green veggies 2x a day?
Do you eat Fruits 2x a day?

Family History
Does anyone in your family have Diabetes
Does anyone in your family have Cancer:
Does anyone in your family have Mental Illness:
Does anyone in your family have Heart issues:
Have you ever been treated for a drug or alcohol problem?

Consent

RCT is focused on educating individuals on Health, Fitness & overall Wellness. Guiding Individuals to a better, safer, more focused way of living. Structured to their way of life.

Consultations at RCT do not include medical advice and are intended to compliment your doctor’s treatment.

Your physician can and should be advised of any information or recommendations in all sessions.
I hereby attest that I am here today and at any subsequent consultation/session, solely on my own personal behalf and/or on behalf of my immediate family to receive nutrition, fitness and lifestyle guidance, that I may choose to apply in my everyday life. I recognize that the services offered by Ryan Rosier & RCT do not involve medical diagnosis or treatments of any disease. I undertake full responsibility for my own wellbeing as it relates to my sessions.

Waiver of liability

Recognizing that participation in any physical activity includes the inherent possibility of both external and internal injury and acknowledging that in Ryan Rosier's capacity as my personal trainer/coach takes every precaution to prevent the above.

As I submit below I waive all legal claims against Ryan Rosier for any injury or damage that I might incur during or as a result of my participation in a training program designed by Ryan Rosier.

Cancellation policy

By submitting this form, I also understand and accept that the full appointment fee will be charged if any cancellations or rescheduling is not done 24 hours prior to the date of my appointment.

Social Media reputation:

By signing up, you grant me permission to capture videos and photos of your journey—from day one until you reach your goal.

This allows me to showcase real client transformations, build my reputation as a proven hybrid coach, and inspire others with tangible results.
Your progress story will motivate someone else to take the first step!