Free Fitness Assessment - Consultation Form

 

Thank you for signing up for your free fitness assessment and consultation at n4workout! We will be in touch as soon as possible to arrange your appointment. However, before we can begin training, we will ask you to fill in a consultation form, so that we can be as prepared to work with you as possible! While you’re feeling motivated, and perhaps have a spare moment at your computer, why not fill it in now, below. It should take around between 5 - 15 minutes to complete depending on the complexity of your health and fitness background!
Regardless of whether or not you choose to train with us in the future, all information submitted remains strictly confidential, and we will never share any of your information with any other parties. If you’re in a rush, no problem, we will email you with a link back to this page within 24hours. If you have any questions regarding the form, or anything else, don’t hesitate to get in touch.

 

About the Free Fitness Assessment:

This will be a routine fitness consultation where we will run you through your consultation form and discuss your medical and exercise history followed by a little light training to review your current fitness level.

The session will start with 30 minutes fitness assessment checking, aerobic fitness, anaerobic fitness and general cardio thresholds (energy systems). We will look at your flexibility, balance, agility and range of movement, moving into general strength and endurance.
We will check your core strength and look at posture, while looking at motivation and an initial discussion about your lifestyle and nutrition. The aim of the session is to enable us to tailor a programme specifically for you to reach your goals should you decide to join us.

 

Consultation Form:

Name *
Name
Address *
Address
Birthday *
Birthday
Pre-ACtivity Questionnaire
Have you ever had a heart condition and been told you should only do physical activity recommended by your doctor? *
Please tick one
Do you have Diabetes Mellitus?
Please tick one
Are you currently or have you ever been prescribed drugs for your blood pressure or heart condition? *
Please tick one
Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
Please tick one
Have either your mother, father or immediate family had a heart attack or died suddenly prior to the age of 55? *
Please tick one
Has your doctor ever said you have raised cholesterol? *
Please tick one
Do you currently smoke cigarettes? *
Please tick one
Do you currently exercise on a regular basis (at least 3 hours a week) and/or work in a job that is physically demanding? *
Please tick one
Are you, or is there any possibility you might be pregnant? *
Please tick one
Do you know any other reason why you should not do physical activity? *
Please tick one
Medical Profile
Have you ever or are you currently suffering from any of the following medical conditions? Please specify as necessary.
Are you currently taking any prescribed medication? *
Please tick one
Maternal Profile (Women Only)
Are you currently pregnant, or trying to get pregnant?
Please tick one
Lifestyle Analysis
Digestive Function and Nutritional Profile
Do you suffer from any of the following? *
On average how many times per day do you move your bowels? *
Goal Setting
Please provide some indication of your preferred days and times.
When would you be able to train with us? *
Please tick as many as apply. This is not an irreversible decision, it will simply help us to allocate you to the most appropriate trainer.
Assumption of Risk
By completing and submitting this form, I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in an exercise program including aerobic and resistance activities. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise which has been recommended to me. *