AH online consulation

Full Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Gender

Age

years

Date of Birth

MonthDayYear

Height

cm

Weight

LBs

Occupation

Whats the activity level at your job?

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 work. (i.e. Gym)

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?

Has anyone of your immediate family developed heart disease before the age of 60?

Do any diseases run in your family?

Do you suffer from diabetes, asthma, high or low blood pressure?

Are you a currently a smoker? (cigarettes/ vapes)

Your current diet could be best characterised as:

What are your fitness goals?

And Why?

How often are you willing/ able to train a week to reach your goal?

Please rate your motivational level to do what it takes for reach your goal.

Have you trained with a personal trainer before?

What are your expectations on me as your Personal Trainer?

1.) PROGRESS PICTURES

Progress pictures are required to track your progress. This will be kept in a private folder and will only been seen by me. If I were to ever share any progress pictures this would be done so with your permission and face would be cropped out.

2.) I confirm am over the age of 16

3.) PLANS WITH PT SESSIONS

If PT sessions are included in your plan and a cancellation is made I will try my best to reschedule that week but this is not always possible. Unless the trainer cancels that weeks payment will still have to be made as usual.

4.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

I AGREE TO THE ABOVE TERMS & CONDITIONS!

Coaching Registration Form