Consultation form

First name

Last name

Email

Phone

Birthday

Day

Month

Year

Next of kin (Name and contact phone number)

If you ticked any of the above options, please provide more information.

Do you take any regular medication/suppliments? if so please provide more details.

Do you have any joint or tendon probems? if yes, please specify

Goals/Targets

Please give a brief description of what our Trainers can help you to acheive.

Do you have a date you would like to achieve these goals by?

Are there any exercises or Fitness Goals you would like to achieve? (eg, run 5k, do 10 push ups, balance on one leg without aid)

Do you have a date you would like to achieve these goals by?

How would you describe your current knowledge of exercise and fitness training?

If you currently exercise, how effective would you say it is?