• Client Information Form

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you have any of the following?
  • Where are you on your menopause journey? (Select one)
  • Are you currently taking any medications or hormones?

  • Symptoms & Challenges

  • Which symptoms are you currently experiencing? (Rate each from 0-5, with 0 being "not experiencing" and 5 being "severely impacting quality of life")

  • Which THREE symptoms would you most like to address during this program?

  • How are your current symptoms affecting your:

  • Lifestyle & Habits

  • How would you describe your current diet? (Select all that apply)
  • How many servings of vegetables do you typically eat per day?
  • How much water do you drink daily?
  • How often do you currently exercise?
  • On average, how many hours of sleep do you get each night?
  • How would you rate your sleepquality?

  • Goals & Expectations

    What are your top THREE goals for participating in this program?

  • Please read and sign this section

    I agree that the information supplied by me on these forms is true and correct.  I declare that I have disclosed on these forms any condition that may affect my ability or capacity to use the facilities and services of Fit For Menopause

    I understand that Fit For Menopause will rely on the information supplied by me either on these forms or at any other time when designing an exercise program and education for me or allowing me to use the facilities and services.

    I understand that during the use of the facilities and services of Fit For Menopause, I release to the full extent permitted by law Fit For Menopause, staff and personnel associated from all liability now arising from:

    a)    Any accidents, loss or damage or injury to my person or my property occurring in the center or any part thereof; and

    b)    Any accidents, loss or damage or injury to any other person or any other person’s property occurring in the center or any part thereof.

    I understand these conditions and agree that the information supplied by me on these forms is both true and correct.

  • Date
     - -
    2 digit day, 2 digit month, 4 digit year

  • Terms and Conditions

  • I agree to be committed to attend my personal training sessions I have booked and to be on time.

    I agree to give as much notice as possible if I am unable to attend. A minimum of 4 hours should be given unless you are injured unexpectedly or you are physically unable to attend, otherwise a fee for the session will apply.

    Payments made by direct debit must be paid by Friday before week of your session: training fees are paid in advance.

    I wish to participate in a regular exercise program designed to increase my muscular strength and endurance, cardiovascular performance, flexibility, posture and body composition.  I understand that adequate hydration and nutrition is essential if I am to achieve the desired results.  

  • I give permission for the appropriate use of any photography on social media medium.

  • I understand and agree to the above terms and conditions.

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: