Fitness Fun

Fun Fitness

Please fill in the form below to sign up:

 

Personal Details

Name: Gender: MaleFemale
Mobile: Daytime Phone: Evening Phone:
Address:
Email:
Occupation DOB:
Favourite Music Favourite Snack
Emergency Contact Phone

Personal and/or Family Fitness

Have you or your direct family had any of the following?
DiabetesHeart ProblemsHigh/low blood pressureStrokeAsthmaChest PainArthritisEpilepsyOsteoporosisHigh Cholesterol

Smoking

Do you smoke YesNo Number Per day
Have you ever smoked? YesNo Number Per day
If you stopped smoking, how long ago did you stop?

Medications

Do you take any pills, tablets, medicine, supplements or medication? YesNo
If yes, please describe

Injury Profile

Have you ever injured any of the following areas of your body?
HeadNeckBackTorsoShouldersArmsHands/WristsHipsUpper LegsKneesLower LegsAnkles/Feet
Please give details about these injuries and how long ago they occurred:
Is there anything else that may affect you exercising

Physical Profile

Weight Pant/Dress Size
Blood Pressure (If known. We will check this when you visit)

Goals

Which of the following lifestyle, health and fitness goals are important to you?
I want to... Get fitterGet strongerBuild muscleLose body fat
I want to feel... More awakeHealthierMore relaxedMore in control
I want to have... More timeLess stressMore energyMore fun

Commitment

How important to you is that you achieve the goals above?
Not VerySomewhatVeryExtremely
What areas are you willing to work on to achieve these goals?
ExerciseNutritionStress/Mood

Motivation

In your experience, which phrase best describes your motivation?
I am self motivatedI find exercise easier to stick to if I have a partnerI find exercise easier with regular appointmentsI usually experience some problems staying motivatedI need constant motivation

Support

Comments
From the following list, who is supportive of you achieving your goals
Family YesNo
Friends YesNo
Work Colleagues YesNo
What are you expecting from your Personal Trainer?

Exercise Preference

1. If you are exercising...
What activities are you doing?
What do you like about them?
Is there anything you don't like about them?
2. If you have previously exercised...
What activities did you do?
What did you like about them?
Is there anything you didn't like about them?
If you trained with weights before, what exercises did you like?
If you have trained with cardio machines before, number these machines (1-5) from favourite to least favourite?
Cycle Cross Trainer Treadmill Stepper Rower
3. For your exercise in the future...
On average, how long would you like to exercise for
On average, how hard would you like to exercise for (On average from 1-10, 10 being extremely hard)?