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Contact Information (* Required Fields)
*First Name:		*Last Name:
*Address:		*County:
*Email:		*Contact Number:
Your Stats
*Age:		*Height (cm):
*Sex:	Female Male	*Weight (Kgs):
		Body Fat % (if known):

What are your fitness / nutrition goals?

Fat Loss Increased Muscle Mass Sport / Performance Improved Nutrition Increased Strength Other

Your Fitness & Health Information

Please specify your health and fitness goals and what you want to achieve:

How many times a week do you workout:

How much time do you spend on each session (minutes):

How intense are your workouts: Please Select 1 Lowest Intensity 2 3 4 5 6 7 8 9 10 Highest Intensity

What kinds of exercises do you do:

What equipment do you have? Barbell (What's This?) Lat Pulldown Machine (What's This?) Dumbbells (What's This?) Seated Row Machine (What's This?) Kettlebells (What's This?) Exercise Bands (What's This?) Medicine Balls (What's This?) Swiss Ball/Stability Ball (What's This?) TRX (What's This?) Bosu Ball (What's This?) Bench Press (What's This?) Cable Ankle Strap (What's This?) Flat Bench/Adjustable Bench (What's This?) Rowing Machine (What's This?) Power Rack (What's This?) Treadmill (What's This?) Squat Rack (What's This?) Elliptical Cross Trainer (What's This?) Chin Ups Bar (What's This?) Heavy Punch Bag (What's This?) Adjustable cable column machine with various handle attachments (What's This?) Bike/Exercise Bike (What's This?) Foam Roller (What's This?) Plyometric Boxes (What's This?) Plyometric Hurdles (What's This?)

How dedicated are you to exercise and diet: Please Select Not Really Dedicated Somewhat Dedicated Very Dedicated

How many years have you been exercising: Please Select Less than 1 1 to 2 3 to 5 5+

When it comes to lifting weights, do you consider yourself: Beginner Intermediate Advanced

What exercises have you done in the past:

Health Information

Do you have any diagnosed health problems or health issues of concern: No Yes

If yes, please explain. This may include but is not limited to diabetes, high blood pressure, chest pains, dizziness, loss of balance, loss of consciousness or joint problems:

Are you currently taking any prescription medications: No Yes

If yes, list any medications:

Are you aware of any reasons, medical or otherwise, that would prevent you from safely partaking in an exercise programme? No Yes

If yes, please state reasons:

Is there any additional information that you would like to add as part of your application? Feel free to highlight any concerns or issues that you would like the training programme to address.

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