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Client information & medical record
How will you attend?
Is this your first time attending?
Has your doctor ever said you should consult them before undertaking activity?
Do you feel pain in your chest during physical activity?
Do you have high blood pressure?
Do you lose balancee, feel light headed or have dizzy spells?
Have you been in hospital in the last 12 months?
Has your doctor ever said you have heart trouble?
Are you currently taking medicine?
Do you suffer from arthritis that is aggravated by exercise?
Are you pre or post natal?
Do you suffer from asthma or breathing difficulties?
Do you suffer from diabetes?
Do you suffer from epilepsy?
Are you healthy enough to train at Body Evolution Fitness
Are you experiencing any stress at the moment? Any mood swings, relationship or work issues for which you would like to recieve some help or resources?
has anyone in your family developed heart disease prior to 60 years old?
Are you taking or recently used any prerscription or over the counter medications?
Symptoms/Conditions?
Have you had any surgical operations in the past 10 years?
Are you currently under doctors care? If so, please give details below.
Have you any concerns that you would like to discuss with me or a doctor?
Do you currently smoke?
Do you drink alcohol?

Personal Goals

Tell me in number order what are your 3 main goals and the timescale that you would like to achieve them in?

Past Exercise History

Are you currently exercising / training? If no skip this section
How long have you been training / exercising?
How many times per week do you train?
Which types of exercising / training do you do?

Lifestyle

Do you work night shifts?
Do you work from home?
What are your daily stress levels?
How many average daily walking steps do you do or think you do per day?
How many average hours do you sleep every night?
Do you get bloated or gassy?

Miscellaneous

Social support

Do the people who spend time with each day follow a healthy lifestyle by exercising or eating healthy foods?
Does your partner or spouse follow healthy lifestyle habits such as exercising regulary and eating healthy foods?
When you want to go for a walk, bike ride, exercise etc is it easy to find a companion to go with you?
At work do your co workers often bring in cakes, sweets, takeaways and other treats?
if you eat out, do the people you eat out with order healthy choices?
Do spend more than 50% of your week with someone who regulary drinks alcohol on a regular basis?
Do you feel like you drink alcohol because of other people (peer pressure)
Do you belong to any groups or social groups that meet up and do some form of physical activity? (not including gym memberships)
Are you a member at a gym or health club?
When discussing your health plan with your friends do they seem interested and keen or are they unsupportive?
Do the people you live with bring home unhealthy foods?
Do the people you live with schedule activities that interfere with your health plan?
Do the people you live with provide you with information on health, nutrition and exercise that could aid you in your health goals?

Thanks for submitting!

Your score

28 to 38

5 to 19

4 to -14

-14 to -31

Terms & Conditions
Small Group Personal Training
& Personal Training

Background


These Terms and Conditions are the standard terms which apply to the provision of Small Group Personal Training (SGPT) & Personal Training Services by Body Evolution Fitness.


This agreement is based on the following provisions:
1. We will deliver you the best possible training and lifestyle programmes in line with your chosen goals.


2. Your results are dependent on you following the programmes/instruction and completing your allocated sessions.


3. You are responsible for your own state of health, physical condition and wellbeing.


4. 24 hours notice is required for all cancellations otherwise you will be charged for the session.


5. Payment must be made in advance of any sessions or assessments being delivered.


1. The agreement is a strict time period as indicated in the weekly schedule provided, not a count of sessions.


6. Unused SGPT sessions will only be carried forward at your coaches discretion.


7. Cancellation or early termination of this agreement will only be considered on the occurrence of one of the following, our decision on this is final:
i) Serious Illness. ii) Accident/Injury. iii) Bereavement. iv) Redundancy v) Relocation to more than 25 miles from our premises.


8. A months notice is required for cancelation of subscription other than the circumstances listed above.


9. Late payments will be charged an extra £10 on top of the requested amount due.  Which will continue for every calendar week until full payment received.


10. Body Evolution reserves the right to cancel subscriptions due to constant late payments.

By ticking 'Yes' below I agree and sign to these terms and conditions

Sign this agreement?
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