AGE REVERSAL PROGRAM

Client Fact-Find, Consent, Baseline & Program Agreement
Version 1.9 - 18.08.26
mrfthat@gmail.com
+44 07935 903549
Blank client record. Save regularly while completing.
MASTER TEMPLATE — Version 1.9 - 18.08.26
This is the clean reference copy. It remains blank and is not used for client data.
Confidential client record. This form captures program information, health and biometric data, recording consent, baseline testing and the client agreement. Identifiable information is for program delivery and agreed supporting practitioners. Anonymised/aggregated outcome data may be used for analysis and promotion as described below.

1. Personal Details

Bio-Age Trajectory Forecast (lifetime projection, age 0–120, illustrative)

This client's chronological age today: , enter date of birth above ,
Solid lines: age to date. Dashed lines from today: illustrative Programme forecast only, not a medical prediction, the actual Biological Age line sharpens once baseline DEXA, VO₂ max and blood work are recorded in sections 9, 12 below. Axis: age in years, 0 to 120.

Biometric Dashboard (actual test results over time)

Log a row every time this client is tested, Baseline, Month 3, Month 6, Month 12, whatever the programme's checkpoints are. Chronological age in blue. Biological age green on any stretch where it's at or below chronological age, red where it isn't.

Date Chronological Age Biological Age

2. Current Physical Data

3. Health & Medical Background

Diagnosed medical conditions
Significant illnesses, operations, injuries or hospital admissions
Physical limitations, pain, mobility problems or issues affecting exercise

4. Medication, Treatment & Supplements

Prescription medication
Prescribed hormone therapy / medically supervised treatment
Supplements

5. Previous Testing & Existing Data

6. Lifestyle: Exercise, Nutrition, Sleep & Stress

Exercise and activity
Nutrition
Sleep, stress & recovery

7. Goals & Your Why

Three photographs

For this standalone version, select images for reference during the session. Browser security prevents embedding local file paths permanently; the portal version will upload them securely to the client record.

Your why

8. Readiness & Commitment

9. Baseline Testing — DEXA

10. Baseline Testing — VO₂ Max

11. Baseline Testing — Mobility & Function

12. Baseline Testing — Blood Work

13. Recording, Data & GDPR Consent

To support delivery of the Program, sessions and assessments may be photographed, audio recorded or video recorded and may be transcribed, summarised or analysed using digital or AI-assisted tools for record keeping, progress tracking and preparation of the client's Program.



Program records may include identity/contact data, health and medical history, medication, supplements, blood-test results, DEXA/body composition, VO₂ max, mobility/function, lifestyle information, photographs, video, audio, goals, progress and outcomes. Health information is special-category personal data. Where consent is relied upon, the client gives explicit consent to its processing for the purposes described here.

Identifiable information will be used privately for Program purposes and may be shared confidentially with practitioners or service providers supporting the client's individual Program, but only to the extent reasonably necessary for their involvement.

Anonymised and/or aggregated outcome information may be used to evaluate and improve the Program, analyse client outcomes and demonstrate results in analytical, educational or promotional material. No client will be named or intentionally identifiable from that aggregated/anonymised information.

Separate permission is required before the Program publicly uses the client's name, identifiable photograph, video, audio, testimonial or individual case study.

Where processing is based on consent, consent may be withdrawn for future processing. Withdrawal does not affect processing already lawfully undertaken and does not apply to information that has already been irreversibly anonymised.

14. CLIENT CONTRACT - Age Reversal Program Agreement

Contract Version 1.9 - 18.08.26
CLIENT CONTRACT — this section forms the Program Agreement for signature and is part of the same client pack.
Select a level to populate price, payments and terms.

1. Program level and service model

Select the Contract Level above.

2. Client responsibilities and compliance

The Client will provide complete and accurate information, disclose relevant health matters, complete agreed testing, attend agreed sessions, provide progress data when reasonably requested and follow the agreed Program in all material respects, subject to agreed changes and any contrary advice from an appropriately qualified medical practitioner.

3. Outcome basis and guarantee

Select the Contract Level above.

4. No medical advice

The Program is coaching and lifestyle support. The Provider does not diagnose disease, prescribe medication, provide medical treatment or replace the Client's doctor or other regulated healthcare professional. The Client is responsible for obtaining appropriate medical advice before beginning or changing exercise, diet, supplements or other health-related practices, particularly where the Client has a medical condition, takes medication or has any concern about suitability. The Client must not discontinue or alter prescribed medication or treatment on the Provider's advice.

5. Assumption of responsibility and risk

The Client remains responsible for their own decisions, conduct and participation in the Program. Physical exercise and lifestyle change can involve inherent risks, and the Client agrees to act within their capabilities, disclose relevant health information and seek medical advice where appropriate. Nothing in this Agreement excludes or restricts any liability that cannot lawfully be excluded or restricted.

6. Limitation of liability

Subject to rights and liabilities that cannot lawfully be excluded or limited, the Provider will not be liable for losses arising from the Client's failure to disclose relevant information, failure to follow medical advice, unauthorised alteration of prescribed treatment, non-compliance with the Program, or acts/omissions of independent third-party practitioners or testing providers. The Provider does not guarantee any outcome other than the additional coaching entitlement expressly described in clause 3.

7. Practitioners and third-party services

The Program may involve independent laboratories, testing facilities, trainers, clinicians or other practitioners. Unless expressly stated otherwise, those providers supply their own services independently and remain responsible for those services.

8. Confidentiality, data and recordings

The Provider will keep identifiable Client information confidential subject to lawful requirements and the Client's data/recording consents above. Relevant information may be shared with agreed supporting practitioners where reasonably necessary. Genuinely anonymised and/or aggregated Program data may be used for analytics, research, Program development and promotion. Identifiable testimonials, photographs, audio, video or case studies require separate express permission.

9. Fees, payment schedule, testing, cancellation and termination

Select the Contract Level above.

Unless expressly included in the selected Contract Level or otherwise agreed in writing, medication, supplements, gym/facility memberships, exceptional travel and independent practitioner services are separate from the Program fee.

Either party may terminate for a material breach that is not remedied within a reasonable period after written notice. The Provider may suspend or terminate participation where continued participation presents an unacceptable safety, conduct or legal risk. Any statutory cancellation rights remain unaffected.

BANK TRANSFER DETAILS

Payments are currently made by direct bank transfer to the Provider personally. Payment should be made using the bank details above and the agreed client/invoice reference.

10. Distance/off-premises cancellation rights

Where the Client enters into this Agreement as a consumer at a distance or away from the Provider's business premises and the statutory cancellation regime applies, the Client may have a 14-day cancellation period beginning on the day after the contract is entered into. The Client may cancel by a clear statement sent to the Provider. If the Client expressly asks for services to begin during that cancellation period and subsequently cancels, the Client may be required to pay a proportionate amount for services supplied up to cancellation, to the extent permitted by law.

11. Intellectual property

Program materials, methods, templates, dashboards and other Provider materials remain the Provider's intellectual property and are supplied for the Client's personal use only unless otherwise agreed in writing.

12. Location of in-person services and travel radius

The Client is accepted into the Program on the basis of the home address stated in this Agreement. Any in-person element of the Program is ordinarily delivered at an agreed location within a radius of up to 10 miles of that address, or at another location expressly agreed between the parties.

The Provider is not required to travel outside that 10-mile service radius because the Client moves home, travels, takes a holiday, works elsewhere or is temporarily resident in another location. Where the Client is outside the agreed service area, coaching and other services that can reasonably be delivered remotely may continue remotely, and any in-person component may be rearranged for a mutually convenient time when the Client is within the agreed service area.

If the Client permanently changes their home address, any resulting change to the location or method of delivery of in-person services must be agreed separately.

Exceptional Travel: By mutual agreement, the Provider may deliver in-person services outside the normal 10-mile service radius. Any such travel is at the Provider’s discretion and the Client will be responsible for the Provider’s reasonable travel, accommodation and associated expenses, with the arrangements and anticipated costs agreed in advance.

13. Dispute resolution, entire agreement and governing law

If any dispute, disagreement or claim arises in connection with this Agreement or the Program, the parties will first seek to resolve it directly and in good faith. If it is not resolved within 14 days of one party giving the other written notice of the dispute, both parties agree to attempt to resolve the matter through confidential mediation with an independent mediator agreed between them before commencing court proceedings.

The parties will cooperate in good faith in selecting the mediator and arranging the mediation promptly. Unless otherwise agreed, the mediator's fees will be shared equally. Any settlement reached and recorded in writing and signed by the parties will be binding.

If mediation does not resolve the dispute, either party declines or is unable to continue mediation, urgent interim or protective relief is required, or a legal time limit requires proceedings to be issued, either party may exercise any legal rights available to them. Nothing in this clause removes or restricts any statutory right a consumer has to bring legal proceedings or otherwise enforce their legal rights.

This Agreement, together with the completed fact-find, agreed baseline methodology and recorded consents, constitutes the agreement between the parties concerning the Program. Changes may be agreed in writing, including electronically. This Agreement is governed by the law of England and Wales and the courts of England and Wales shall have jurisdiction, subject to any mandatory consumer rights concerning jurisdiction.

Client acceptance
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