Full Name
*
First Name
Last Name
Gender
Male
Female
Age
years
Height
cm
Weight
KG
Do you follow a regular working schedule, do you work days, afternoon or nights?
Please list the physical activities that you participate in outside of the gym and outside of work.:
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Are you experiencing any stresses or motivational problems?
Yes
No
Has anyone of your immediate family developed heart disease before the age of 60?
Yes
No
Do any diseases run in your family?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
if yes please list:
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
What following goals does best fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
What is your goal with your training?
Why?
How often are you willing to train a week to reach your goal?
Please rate your motivational level to do what it takes for reach your goal.
1
2
3
4
5
6
7
8
9
10
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Have you trained before. If yes what kind of training did you do:
What are the timings that suit you?
7-8 am
8-9 am
9-10 am
1-2pm
2-3 pm
5-6 pm
6-7 pm
7-8 pm
8-9 pm
Which package would you like to take
1 month only 450
3 months 425 p month
6 months 400 p month
1 year 350 p month
1 month with meal plan 1500
Subscription 450 AED
Ready to make a change and join
Submit
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