PERSONAL DETAILS
NAME:
EMAIL:
PHONE:
Have you ever had or do you have any of the following:
Please tick to indicate "yes" or "unsure":
* If you indicated 'yes' to any of the above it may be necessary for you to seek medical clearance from your doctor prior to commencing an exercise program.
Have you ever had or do you have any of the following:
Do you or have you ever suffered from pain or major injury in the following areas:
Are you currently dieting or fasting?
Do you smoke?
Are there any other conditions or injuries that may inhibit you from safely undertaking an exercise program?
Are you currently under the care of a doctor, chiropractor, or other health care professional for any reason?
Are you taking any medications?
Please check the box that best describes your work habits:
How would you describe your current lifestyle with regard to stress?
What time do you wake up in the morning and go to bed in the evening?
Are you currently exercising? If yes, what type of exercise do you do and how many days per week? If no, how long has it been since you last exercised?
Please describe:
How many days per week are you able to devote to your exercise program? Please be realistic with your estimate and include the duration of time you are able to spend per session.
What do you hope to achieve from this program?
On a scale of 1-10 how important is it for you to achieve these goals?
ACKNOWLEDGEMENT
I acknowledge that . . . The answers to these questions are useful as a guide to any obvious limitation of my ability to exercise. They do not constitute a medical or physical assessment of such ability. I understand that Phat Physique Personal Training is not able to provide me with advice concerning my medical fitness to undertake any exercise program or activity offered. I understand that it is my own responsibility to seek medical advice in this regard, and I release and indemnify Phat Physique and its owners and employees from liability for injury or illness incurred by me arising out of my undertaking an exercise program.
I declare that the information that I have given is accurate to the best of my knowledge and will be treated as confidential and as such will not be released or revealed to any person. I acknowledge that exercise is not without some risk and known danger.
I hereby understand, acknowledge and accept the risks and known dangers and certify that I have voluntarily elected to participate in any exercise session / fitness evaluated conducted by Phat Physique Personal Training. I agree to be bound by the terms and conditions set out by Phat Physique Personal Training, its owners and employees. I hereby release to the full extent permitted by law, the owners and employees from all claims and demands of every kind with respect to any accident, damage, injury, loss to person or property, pain and suffering however caused. I wholly indemnify the owners from any actions, suits, demands, claims, costs, damages and expenses to which the owners are or may be liable.
