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Personal Information
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Indicates required field
Name
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First
Last
Email
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Contact Number
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Date of Birth
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Address
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Emergency contact
Name
*
Relation
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Contact Number
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Pre-Exercise Questionnaire
Do you have or have you had any of the following?
Heart Disease or any other Cardio Vascular condition?
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Yes
No
High Blood Pressure?
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Yes
No
Any History or coronary heart disease in your family?
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Yes
No
A major Illness or surgery in last 5 years?
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Yes
No
Diabetes?
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Yes
No
Do you smoke?
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Yes
No
Arthritis or other joint/muscular pain?
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Yes
No
Asthma or difficulty breathing?
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Yes
No
Epilepsy?
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Yes
No
Dizziness, blackouts or fainting spells?
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Yes
No
Are there any other conditions or medical problems which may be reasons to modify your exercise program?
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If you have said YES to any of the above, you need a signed medical clearance from your doctor before starting exercise.
By ticking this box I warrant that I am physically and mentally well enough to proceed with usage of the facility.
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Yes
I agree to receiving marketing and promotional materials
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Home
About
Programs
Personal Training
Online Training
Success Stories
Contact
Blog