Fitness Evaluation

Please consult with your doctor prior to starting an exercise program and prior to purchasing this program.

By checking the “I agree” checkbox, I am signing this release. I am stating that I am in excellent physical health and that I am fully aware that there are risks associated with participating in physical activity. My participation is completely voluntary and I freely accept and fully assume all responsibility for all risks and all possibility of personal injury or death as a result of my participation in this exercise program.

 I agree

Your Name (required)

Your Phone # (required)

Your Email (required)

Have you exercised before?
 Often Rarely Never

If so what form has that exercise taken? (I.e. playing sports, going to a gym etc.)

If you have gone to the gym what program have you followed?

Have you ever used a personal trainer?
 Yes No

Has a personal trainer ever created a detailed exercise program for you?
 Yes No

If you have worked with a trainer please supply some details of that training: how many sessions, how long ago, at what level or intensity?

Do you have any injuries that I should be aware of?

If you do have any injuries, have you ever had physiotherapy?
 Yes No

If you have had physiotherapy please supply If you have had physiotherapy please supply some details: How long ago did you do the therapy? : How long ago did you do the therapy?

What exercises did they give you to do? Did they clear you for regular exercise?

Please list 5 fitness goals:

How many hours can you dedicate to exercise per week?

How many days a week can you plan to exercise?

Please describe where you will be doing your exercise program and what kind equipment the location has (for example: home gym, condo gym, fitness centre etc).

How would you describe your body type? (long and thin, muscular)

Where do you feel you hold your weight?

If you have exercised in the past did you...
 feel like you bulked up quickly feel it was hard for you to put on muscle mass?

Do you feel like you slouch when you stand?
 Yes No

Do you feel like your head sits forward from the rest of your body?
 Yes No

What is the best time to contact you by phone?

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