Lamiss Fitness Signup Form

Welcome to Lamiss Fitness!

Thank you for choosing me to be your personal trainer. In order for you to get the most out of our sessions, I need some information about your general state of health, your lifestyle & food choices. I will also ask you to take & upload some pictures so we will be able to track your progress.

Personal details

Tell me about yourself
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Birth Date*

DayMonthYear
Male or Female*

FemaleMale
Weight*
Weight in kilos
Height*
Height in cm

Please consult a physician

If you answered yes to one or more questions, are older than age 40 and have been inactive or are concerned about your health, consult a physician before taking a fitness test or substantially increasing your physical activity. You should ask for a medical clearance along with information about specific exercise limitations you may have.

Pregnancy & Childbirth

A few quick questions about your experience with childbirth & pregnancy
How many biological children do you have?*
Please enter the number
When did you last give birth?*

DayMonthYear
Date
How did you give birth?*

Vaginal deliveryC-section
Is there anything else about your birth experience I should know?*
Are you currently Pregnant?*

YesNo
Congratulations! When are you due?*

DayMonthYear
What is the due date?
is there anything I should know about how your pregnancy is going or your birth plans?*

Lifestyle and Behaviour Related Questions

Nutrition
Overall, how would you describe your nutrition?*
Do you drink at least 8 glasses of water each day?*

YesNo
How many meals a day do you eat?*
Min. 1, max. 8
Briefly describe when you eat each meal and what you typically eat.
Meal 1*
When do you eat this meal? What kinds of foods would you typically have?
Meal 2*
When do you eat this meal? What kinds of foods would you typically have?
Meal 3*
When do you eat this meal? What kinds of foods would you typically have?
Meal 4*
When do you eat this meal? What kinds of foods would you typically have?
Meal 5*
When do you eat this meal? What kinds of foods would you typically have?
Meal 6*
When do you eat this meal? What kinds of foods would you typically have?
Meal 7*
When do you eat this meal? What kinds of foods would you typically have??
Meal 8*
When do you eat this meal? What kinds of foods would you typically have?
Do you take vitamins or supplements?*

YesNo
Please list the vitamins you take*

Lifestyle and Behaviour Related Questions

Caffeine, alcohol & smoking
How many cups of coffee do you have per day?*
Enter a number
How many glasses of alcohol do you drink per week?*
Enter a number
Do you smoke?*

YesNo

Participant agreement

Thank you for all the information. Next, please read and sign the release form below. (You will receive a copy by email once you have submitted the form)
I, {name}, wish to start a Personal Fitness Program with LAMISS FITNESS. I understand there are some risks in participating in a program of strenuous exercise. Consequently, I have been examined by a physician of my choice and obtained his/her approval for my participation in this program within sixty days of the date set forth below. No change has occurred in my physical condition since the date such approval was given which might affect my ability to participate in the fitness program.

1. I certify that the answers to the questions outlined on the Physical Actitivity Readiness Questionnaire (PAR-Q) on page 2 of this form are true and complete to the best of my knowledge. I acknowledge that medical clearance is required if I have answered YES to any of the questions on the PAR-Q form.

2. I understand and agree that it is my responsibility to inform my Personal Trainer of any conditions or changes in my health, now and ongoing, which might affect my ability to exercise safely and with minimal risk of injury.

3. I understand that should I feel light headed, faint, dizzy, nauseated or experience
pain/discomfort that I am to stop the activity and inform my Personal Trainer.

4. I understand the results of any fitness program cannot be guaranteed and that my progress
depends on my effort and cooperation in and outside of the Personal Training session.

I have read this Release and Terms of Agreement and understand all of its terms. I sign it voluntarily and with knowledge of its significance.

...and finally, some pictures

I would like you to take some pictures of yourself. This will help us track your progress - change can happen fast and it is really important to have an accurate record of where you started.
Your Front*

Exactly like in this picture (neutral position) so I can see your posture, your shoulders, your butt and thighs well
Cancelof
Your side*

Exactly like in this picture (neutral position) so I can see your posture, your shoulders, your butt and thighs well
Cancelof
Your back*

Exactly like in this picture (neutral position) so I can see your posture, your shoulders, your butt and thighs well
Cancelof
Should be Empty:

Rows	Not Applicable	Not important	Average	Very Important
Reduce Fat
Tone Muscles
Improve Sport Specific Skills
Increase Flexibility
Improve Cardiovascular Fitness
Build Muscle Mass
Improve Exercise Technique
Increase Motivation
Improve Health
Improve Eating Habits
Pre/Post-natal care
Rehabilitation
Reduce Stress
Add variety to Exercise Regime

Welcome to Lamiss Fitness!

Personal details

Physical Actitivity Readiness Questionnaire (PARQ)

Please consult a physician

Pregnancy & Childbirth

Fitness Related Questions

Goal Setting

Lifestyle and Behaviour Related Questions

Lifestyle and Behaviour Related Questions

Lifestyle and Behaviour Related Questions

Lifestyle and Behavior Related Questions

Participant agreement

...and finally, some pictures