CLARITY COACHING
  • CLARITY COACHING

    CLARITY COACHING

    Contact Details
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  • Health Evaluation

    Personal Information
  • Date Of Birth
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  • Health Evaluation

    Par-Q
  • Has your doctor ever said that you have a heart condition, or that you should only do physical activity prescribed by a doctor?*
  • Do you feel pain in your chest when you do physical activity?*
  • In the past month, have you had chest pain when you were not doing physical activity?*
  • Do you lose your balance because of dizziness or do you ever lose consciousness?*
  • Do you have bone or joint issues (for example, back, knee and hip) that could be made worse by a change in physical activity?*
  • Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
  • Is there any other reason why you should not be partaking in physical activity?*

  • Lifestyle Questionnaire

  • Do you smoke?*
  • Do you drink?*
  • How active are you?*
  • How experienced are you in the gym?*

  • Extra Information

    Goals, Experience, Needs Etc
  • What Service Have You Chosen

  • Informed Consent

  • Informed Consent for Personal Training and Online Coaching

    I'm excited to work with you to help you achieve your fitness goals. This form explains the nature of our coaching relationship, potential risks, and your responsibilities. Please read it carefully and let me know if you have any questions before signing.

    1. Nature of the Service:

    As your personal trainer and online coach, I will provide guidance and support to help you reach your fitness goals. This may include:

    * Developing personalized workout plans
    * Providing nutritional guidance and meal suggestions
    * Offering support and motivation
    * Tracking your progress and making adjustments as needed

    2. Qualifications:

    I hold the following certifications and qualifications: Level 2 YMCA GYM Instructor, Level 3 YMCA Personal Trainer, Level 3 Fitness Services

    3. Potential Risks:

    Physical activity carries inherent risks, regardless of how carefully you follow instructions. These risks include, but are not limited to:

    * Muscle strains and sprains
    * Joint pain
    * Cardiovascular events (e.g., chest pain, dizziness)
    * Injuries from improper form or technique

    4. Client Responsibilities:

    Your success depends on your commitment and honesty. You agree to:

    * Disclose any pre-existing medical conditions or injuries
    * Follow the workout and nutrition plans to the best of your ability
    * Communicate any pain or discomfort immediately
    * Obtain clearance from your physician before starting any new exercise program

    5. Confidentiality:

    I will keep your personal information and progress confidential, except as required by law.

    6. Cancellation Policy:

    More than 24 hours notice (No charge)

    Less than 24-12 hours notice (50% of the full session)

    Less than 12 hours notice (Full session charge)

    7. Disclaimer:

    I am not a medical professional. The advice and guidance I provide are not intended to be a substitute for professional medical advice. Always consult with your physician before making any changes to your diet or exercise routine.

    8. Agreement:

    By signing below, you acknowledge that you have read and understand this informed consent form, and you agree to participate in personal training and online coaching services with Preston Tipple or Clarity Coaching under the terms outlined above.

  • Date of signature *
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