Exercise Questionnaire
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Email *
Name
Surname
Contact Number
Birth date
MM
/
DD
/
YYYY
Weight
Height
Please indicate if any apply
Any other ailments or medical conditions we should know about?
Waiver and indemnity I understand that the training program designed for me is dependent on the information provided and I therefore take full responsibility for any injuries that might occur as a result of incorrect information provided. I understand that if I am not entirely sure about the state of my physical health, it is advised that I consult a physician to declare me medically fit to participate in exercise before commencing this program.
How active are you per week
Clear selection
What sport(s) do you participate in
Running
Cycling
Swimming
Gym
Other
How long have you been doing the sport less than 2 years
How long have you been doing the sport more than 2 years
Level Recreational
Level Serious
Rate your fitness level with 1 being the least fit and 5 being extremely fit
If you selected Other please specify what other sport you participate in as well as intensity and frequency
Any exercise related injuries/niggles
What do you consider your strengths/weaknesses?  
What are your short and medium term goals?
When do you prefer to exercise?
Clear selection
How much time do you have to exercise daily?
Which days do you prefer as your exercise and rest days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Exercise days
Rest Days
What events are you currently training for?
What activities do you participate in or enjoy and want to form part of you exercise routine
Please give us a 1 week breakdown of your current exercise routine.
Do you have a heart rate monitor ?
Do you belong to a gym or have access to a gym?
Any other information we need to know?
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