Your Name (required)
Your Email (required)
Date of Birth (required)
Height in cm (required)
Your weight in kg (required)
Your waist at the navel in cm (required)
Your hips at the widest point in cm (required)
Blood presure (if known)
Body fat % (if known)
Body cholesterol (if known)
Your job
Do you smoke? If so how many a day (leave blank if you are a non smoker)
Do you drink? If so how much do you drink in a week? (leave blank if you don't drink)
On average, how many hourse sleep do you get each night?
Please give details for each activity
Sport/Fitness training
Job - Manual? Office
Day to day - e.g. walk to work, walk the dog etc
Previous Sports/Fitness experience and history
Give dates and details
Details of any injuries or medical conditions that may affect your ability to train
You are requied to answer all of these questions
Has your doctor ever said that you have a heart condition and recommended only medically supervised activity? yes no
Do you have chest pain brought on by physical activity? yes no
Have you (or a family member) ever been told that you have diabetes? yes no
Do you tend to lose consciousness or fall over as a result of dizziness? yes no
Has a doctor ever told you your blood pressure was too high? yes no
Do you have any injuries or orthopedic problems? yes no
If you answered yes, please give details
Are you aware through own experience or from a doctors advice, of any other physical reason why you should not exercise without medical supervision? yes no
Are you currently, or have you been pregnant in the last six months? yes no
Do you have any other health problems or medical conditions not previously mentioned? yes no
Are you taking any prescribed medications or dietary supplements? yes no
I confirm that the information I have supplied is true and to the best of my knowledge
