If you wish to book a free consultation please fill in the form below and we will contact you.* It is important to enter your email address

Name

Address

Home Tel

Work Tel

Mob Tel

* Email

D.O.B Occupation

How did you hear about Total Fit?

Have you ever suffered from heart disease or high blood pressure? YES   NO

Is there any history of heart disease in your family? YES   NO

Do you suffer from any chest complaints? YES   NO

Do you often get headaches, feel dizzy, light headed? YES   NO

Do you suffer from any stiffness or joint problems? YES   NO

Have you had any exercise related injuries? YES   NO

Are there any specific movement or activities that aggravate the above condition? YES   NO

Are you under any medication at present? YES   NO

If so any side effects? YES   NO

Do you smoke? YES   NO if so how many per day?

How many units of alcohol do you drink per week? ( 1 unit = 1/2 pint beer, 1 glass of wine or 1 shot of spirit.)

Have you under gone any recent surgery? YES   NO

Are you pregnant or have given birth in the last eight weeks? YES   NO

Do you have diabetes mellitus? YES   NO

In general, do you think you are in good health? YES   NO

Exercise Profile

What types of exercise have you done in the past year?

Do you take regular exercise? YES   NO

What kind of exercise do you enjoy?

What physical activity has worked for you in the past?

What kind of training are you looking for?

Do you have any negative feelings towards exercise, or have you had any bad experience with exercise? YES   NO

How much time do you have available to train? per week

What are your aims?

Do you feel stressed? YES   NO

What makes you feel stressed?

How do you deal with stress?

How many meals do you have a day?

What is your worst eating habit?

What would increase your motivation?