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Home
About
Training Services
Mobile PT
Online PT
Testimonials
Health Tips
Healthy Recipes
Health & Fitness Tips
Contact
Pre-Exercise Questionnaire
All questions marked with a * are required.
* Name:
* Date of Birth
* Address:
* Email Address:
*Phone Number:
* Emergency Contact Name:
* Emergency Contact Phone Number:
* When did you last visit the Doctor?
* Has your Doctor ever advised you against moderate to high intensity exercise?
* Do you have any pre-existing injuries that you feel your trainer should be informed of?
Yes
No
If yes, please detail:
* Do these pre-existing injuries affect any movement that you have to do now? (Moving arms above head, holding weights, etc.)
Yes
No
Please select from the list
Back Pain
Neck Pain
Knee Pain
Ankle Pain
If others, please detail:
* Do you have any medical conditions that you feel your trainer should be aware of?
Yes
No
Please select from the list
Heart Condition
High Blood Pressure
Low Blood Pressure
Epilepsy
Arthritis
Asthma
Diabetes
Kidney Condition
Liver Condition
Dizziness
Headaches
If others, please detail:
* Are you taking any medications?
Yes
No
If yes, please detail:
* Are you aware of any hereditary conditions that your trainer should be made aware of?
Yes
No
If yes, please detail:
* What is your biggest motivation for commencing training?
* How many hours a night do you sleep?
* Is it enough?
Yes
No
* What’s your stress level in general (on a scale 1-10)?
* How is your level of energy/focus throughout the day (1-10)?
* Are you currently engaging in regular exercise (≥3 sessions/week)?
Yes
No
If yes, please detail:
If no, when were you last active:
* How would you rate your current fitness level (1-10)?
* Please give detail:
Is there anything else you would like to inform us about?
