Fitness Class Enrolment Form

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Fitness Class Enrolment Form

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Fitness Class Enrolment Form

Before you begin your first fitness class with Aaron Morton Training please could you complete the following health form so I can be informed by any health issues that may influence your fitness class participation.

Thank You,

Aaron Morton

Name*
Address*
Email Address*
Emergency Contact Details (Only Fill Out If Having PT Package)
Doctors Details (Only Fill Out If Having PT Package)
Have You Experienced Any Heart Problems*
If 'Yes', Specify in what in 'other' box
- Yes
- No
Do You Have Diabetes?*
If 'Yes', Specify in what in 'other' box
- Yes
- No
Have You Ever Had A History Of Cancer?*
If 'Yes', Specify in what in 'other' box
- Yes
- No
Do You Suffer From Epilepsy?*
- Yes
- No
Do You Ever Experience Pains In Your Chest or Heart During Physical Activity?*
If 'Yes', Specify in what in 'other' box
- Yes
- No
Do You Ever Get Dizzy Spells?*
If 'Yes', Specify in when in 'other' box
- Yes
- No
Do You Get Out Of Breathe Easily?*
If 'Yes', Specify in when in 'other' box
- Yes
- No
Do You Have Joint or Bone Problems That Could Be Aggravated By Exercise?*
If 'Yes', Specify in what in 'other' box
- Yes
- No
Has Your Doctor Ever prescribed Medication For Blood Pressure Or Heart Conditions?*
If 'Yes', Specify in what in 'other' box
- Yes
- No
Are You Currently Pregnant?*
- Yes
- No
Have You Given Birth Within The Last 2 Years?*
If 'Yes', Specify in when in 'other' box
- Yes
- No
Have You Been Advised Against Physical Activity By Your Doctor?*
If 'Yes', Specify why in 'other' box
- Yes
- No
Have You Had Any Surgery In The Last 10 Years?*
If 'Yes', Specify what in 'other' box
- Yes
- No
Do You Have High Blood Pressure*
If 'Yes', Specify when last tested in 'other' box
- Yes
- No
- Not Sure
Do You Have High Cholesterol?*
If 'Yes', Specify what and when last tested in 'other' box
- Yes
- No
- Not Sure
Do You Have A History Of Heart Disease In Your Family?*
- Yes
- No
- Not Sure
Do You Smoke?*
If Used To, Specify When You Quit In The 'Other' Box
- Yes
- No
Please Specify In The Box Anything Else Not Covered Above You Think I Should Know In Relation To Your Health & Medical History?
On A Scale 1-10 (1 Mega Stressed - 10 Mega chilled) How would rate your levels of stress?*
What Factors Would You Say Stress You Out The Most On A Regular Basis?*
On Average How Many Hours Sleep Do You Get A Night?*
How Would You Rate The Quality Of Your Sleep? (1 - Have trouble getting to sleep & regularly wake up - 5 I'd sleep through a hurricane)
How Would You describe Your Energy Levels Over The Day?*
Describe what an ideal fitness class would involve for you?*

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