When you first start training with us, we ask you to fill out this health history questionnaire and submit it online, or you can download and print out a PDF copy and bring it with you to your consultation.

Thank you, and we look forward to meeting you!

Your Details

Health and Fitness Goals

Which of the following lifestyle, health and fitness goals are important to you? I want to increase fitnessI want a faster metabolismI want to get strongerI want to build muscle

Rehabilitation and/or Pain Relief for your: BackKneesShouldersOther

Your goals include : Weight LossFat LossMuscle ToneFitness

How important is it for you to achieve these goals? Extremely ImportantVery ImportantImportantIf it happens, it happens

Which days of the week are best for you to include exercise? MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Your health check

Do you have any medical conditions that you think may prevent you from exercising? YesNoUnsure

Do you have or do any of the following conditions exist in your family history? AsthmaDiabetesHigh or Low Blood PressureHigh CholesterolHeart ProblemsEpilepsyDizzinessChest PainArthritisOsteoporosisOther

Do you have any joint problems, aches, pains or injuries-past or present?

Do you have any other conditions you think we should know about?

Please list any medication, medicine, multivitamins or supplements you are currently taking:

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? YesNo

Do you feel pain in your chest when you do physical activity? YesNo

Are you or have you recently been pregnant? YesNo

We are happy to recommend that you consult with your doctor before you start any exercise program.

Are you currently exercising? YesNoSometimes

Are you physically inactive (i.e. you get less than 30 minutes of physical activity on at least 3 days per week) YesNoSometimes



What do you really want/expect from your trainer and exercise program?

Is there any other information that you believe is relevant or do you know of ANY other reason why you should not engage in physical activity? If so, please explain.

Please read the following and confirm you have read it.

I Agree to the following conditions

WARNING – THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR RIGHTS
AGREEMENT FOR PARTICIPATING IN PHYSICAL EXERCISE AND PHYSICAL ACTIVITIES

  1. I acknowledge that it is a condition of participating in this Activity that I do so at my own risk. I accept all risks and hereby indemnify and release the Trainer, their agents, affiliates, employees, members, sponsors, promoters and any person or body directly or indirectly associated with the Trainer, against all liability (including liability for their negligence and negligence of others), claims, demands and proceedings arising out of or connected with my participation in this Activity. This release and indemnity continues forever and binds my heirs, successors, executors, personal representatives and assigns.
  2. I acknowledge that participating in this activity may involve a risk of serious injury or even death from various causes including but not limited to: over exertion, dehydration, equipment failure and accidents with equipment, surroundings or other participants.
  3. I recognize the difficulties associated with the Activity and attest that I am physically fit to participate safely in the Activity and that qualified medical practitioner has not advised me otherwise.
  4. I understand the demanding physical nature of this Activity. I am not aware of any medical condition, detrimental to my health if I participate in this A condition, injury or impairment in this Activity my trainer shall be immediately informed. By continuing to participate in this Activity, I accept the risks despite these conditions and am still, and will always be under the terms of this agreement.

I certify that I am 18 years or older and have read this document and fully understand it. As a parent or guardian of the participant

  1. I agree to the above for myself and on behalf of the participant and
  2. I indemnify and will keep indemnified any person or body directly or indirectly associated with the conduct of the activity on the terms referred to.

Yes, I have really read these conditions and agree to them

digitally signing on behalf of