CONTACT | Train Fitness Professionals

Name

First Last

Email*

Phone

Emergency Contact (name)

First Last

Relationship

mother/father/partner/husband/wife/child/friend etc

Emergency Contact (phone)

Medical Pre Screen

Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*

Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?*

Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*

Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*

If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*

I don't have diabetes
I have diabetes, but my blood glucose is well controlled
I have diabetes and my blood glucose has not been well controlled (in the last 3 months)

Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?*

If yes, please advise further below

Are you currently pregnant?*

Have you given birth in the last six months?*

Are you allergic to food, medications, pollens or other allergens or specific environments?*

If yes, is this an anaphylactic reaction?

If yes to any of the above questions, please advise further below

Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?*

If yes, please advise further below

Training Location

Let us know which class you would like to trial

Let us know the name, time and day. If unsure leave this part blank and we will be in touch to discuss

I am interested in these types of sessions:

tick all that apply

Trial date

Do you want to let us know anything else?