RESULTS with REN Consultation Form

Full Name

First NameLast Name

Gender

Date of Birth

MonthDayYear

Age

years

Height

cm

Weight

KG

What do you do for a living?

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 the gym and outside of work.:

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?

Please list:

Are you a current cigarette smoker?

Your current diet could be best characterized as:

Please rate your readiness for change.

What following goals does best fit in with your goals?

What is your goal with your training?

Why?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

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

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

Are you currently exercising regularly (at least 3x per week)?

Have you trained with a personal trainer before?

What kind of training did you do?

At what times during the day would you prefer to train?

How often do you want to do Personal Training a week?

Please Choose

What are your expectations on me as your Personal Trainer?

1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full.

All online sessions will be scheduled in your apps online calendar. If for any reason you cannot complete a session- please ensure you communicate this with me and we will get you back on track as soon as possible.

2.) PAYMENT

For all sessions payment is required in full.
This can be done seamlessly via the app- or bank transfer. Sessions must be split over the course of a ONE calendar month. For example if you book 12 sessions, you may opt for 3 sessions a week.

3.) 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!