L. TOMASELLO
PERSONAL TRAINING
Contact Information
Full Name
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First Name
Middle Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
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example@example.com
Emergency Contact Name
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Emergency Contact Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Health & Readiness Questionnaire
Are there any injuries or physical limitations I should know about?
Has a doctor ever said you have a heart condition and that you should only perform physical activity recommended by a doctor?
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Yes
No
Do you feel pain in your chest during physical activity?
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Yes
No
Have you had chest pain in the past month when not doing physical activity?
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Yes
No
Do you lose balance because of dizziness or ever lose consciousness?
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Yes
No
Do you have a bone or joint problem that could be made worse by a change in physical activity?
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Yes
No
Is a doctor currently prescribing medication for blood pressure or a heart condition?
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Yes
No
Are you pregnant or have you given birth within the last 6 months?
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Yes
No
Do you have any diagnosed condition not listed above that may affect your ability to exercise safely?
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Yes
No
Is there any other reason you should not do physical activity?
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Yes
No
If you answered YES to any question, please explain
Current medications
Allergies
Liability Waiver & Informed Consent
I understand that participation in a personal training program involves physical exertion and carries inherent risks, including but not limited to muscle strain, joint injury, cardiovascular strain, and in rare cases, more serious injury. I confirm that I have disclosed all relevant health information on the Health & Readiness Questionnaire above to the best of my knowledge. I voluntarily choose to participate in personal training sessions with L. Tomasello, and I understand that I may stop or modify any exercise at any time if I feel discomfort, pain, or believe continuing is unsafe. I release L. Tomasello from liability for any injury, loss, or damage that may occur as a result of my voluntary participation in training, except in cases of gross negligence or intentional misconduct. I understand that results from any training or nutrition guidance are not guaranteed, and individual outcomes vary based on effort, consistency, genetics, and other factors outside the trainer’s control.
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Signature
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I give permission for L. Tomasello to contact me via phone, text, or email regarding scheduling, program updates, and check-ins.
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Signature
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Cancellation Policy: Sessions require at least 24 hours' notice to reschedule. Cancellations within 24 hours of the session may or may not be able to be rescheduled.
Signature
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Type a question
I have read, understood, and agree to the terms outlined above.
Client Name (Printed)
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Client Signature
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Date
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Month
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Day
Year
Date
Parent/Guardian Signature (if client is under 18)
Parent/Guardian Date
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Month
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Day
Year
Date
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