Professional Documents
Culture Documents
Date of birth:
Address:
Postcode:
Number:
Surgery address:
Relation:
Number:
Occupation: Medical history (i.e. injuries or illnesses) Have you had any recent injuries or illnesses? Yes/no (if yes please tick the boxes) Heart attack Sunburn Stroke High blood pressure Asthma Seizures Sunstroke Diabetes Cancer Fever Viral infection
Are you pregnant? Yes/no (if yes please state how many weeks) Have you recently visited your GP? Have you had any operations recently? Is there anything else I need to know about? Lifestyle Do you smoke: yes/no Do you drink alcohol: yes/no Do you take drugs: yes/no How many hours do you sleep: Are you allergic to anything: Is there anything that you cant do: What do you want to achieve in this training program: Do you stress and what causes you to stress: How many litres of water do you drink per day: Physical Examination Height: Weight: BMI: Body fat %: Blood pressure: Lung function: Postural Analysis
Declaration I understand that all information is kept confidential and private unless permission is given to disclose. Any changes in my personal circumstances must be given to personal trainer immediately. I hereby indemnify the personal trainer against any adverse reaction sustained as a result of treatment I understand the training plan that has been proposed to me/ I confirm all the information above is correct. Client signature: Date: Personal trainer signature: Date: