Please take time to make sure all parts of this form are filled in correctly before you press submit Remember, all fields marked with '*' are mandatory

Once the form is completed you will be transfered to the 'Order Completition Page'. After finishing the order you will then be taken to my 'Online Diary' to finally bookmup the date and time for your first session.
PERSONAL TRAINING - Exercise Readiness Questionnaire
Your Name *
Your Email Address *
Age *
Weight (Stones / Lbs / Kgs) *
Height (Ft / Cm) *
Gender *
 Male 
 Female 

General Sporting Lifestyle

Describe your current sporting status.
What sporting activity are you involved in? *
If other, then what sport is it?
How long have you been involved in this sport? *
At what intensity level do you train?
 Low 
 Medium 
 High 
Do you compete at your sport?
 Yes 
 No 

Training Objectives

Future goals.
What are your future training objectives? *
 Gain weight 
 Gain muscle mass 
 Increase strength and power  
 Loss weight 
 Loss body fat 
 Get fit 
 Tone up 
 Healthier lifestyle 
 Feel good factor 

General Health Status

Any major illness in the past 5years? *
 Yes 
 No 
Do you suffer from any illness, which could affect your training *
 Yes 
 No 
Are you seeing a doctor for any medical problems? *
 Yes 
 No 
Do you have any special nutritional or medical requirements? *
 Yes 
 No 
Do you feel overly tired during the day with normal activity? *
 Yes 
 No 
Do you have any
 Respiratory problems 
 Circulatory problems 
 Digestive problems 
 Back/joint problems  
If the answer is yes to any of above, please explain
Have you been diagnosed by a doctor with high blood pressure? *
 Yes 
 No 
Have you been diagnosed by a doctor of having
 Diabetes 
 Heart Problems 
 High Cholesterol  
Have any of your family been diagnosed by a doctor of having
 Diabetes 
 Heart Problems 
 High Cholesterol 
Any additional comments?
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NOTE: THANK YOU FOR ORDERING OUR 'PERSONAL TRAINING SESSIONS'