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Gym sign up
Please complete the form below, to ensure that we have all the correct details for you during your time at ASC Performance.
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Email
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Your email
Full name
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Your answer
Date of birth
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Best contact number
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Your answer
Address
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Your answer
Emergency contact name
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Your answer
Emergency contact number
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Your answer
Where did you first hear about ASC Performance?
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Your answer
How long have you been following ASC Performance?
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Less than 1 week
1 week to 1 month
1-6 months
6 months - 1 year
1-3 years
3+ years
What led to you signing up?
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Your answer
What are your main goals?
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Your answer
Why are these important to you?
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Your answer
How are you currently training?
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Your answer
What has worked the best for you in the past?
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Your answer
What has not worked well for you in the past?
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Your answer
What are your biggest frustrations with health and fitness?
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Your answer
What normally stops you from reaching your goals?
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Your answer
Are there any exercises you particularly like, dislike or have issues with?
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Your answer
How often a week would you like to train at ASC?
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Your answer
Please describe your current approach to nutrition?
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Your answer
Current weight & height
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Your answer
Do you currently have any diagnosed medical conditions? If yes please detail here.
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Your answer
Has your doctor ever said that you have a heart condition and that you should not perform physical activity? If yes, please detail here.
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Your answer
Do you feel pain in your chest when you perform physical activity? If yes, please detail here.
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Your answer
In the past month have you had chest pain when you were not performing any physical activity? If yes, please detail here.
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Your answer
Do you lose your balance because of dizziness or do you ever lose consciousness? If yes, please detail here.
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Your answer
Do you have a bone or joint problem that could be made worse by a change in your physical activity? If yes, please detail here.
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Your answer
Is your doctor currently prescribing any medication? If yes, please detail here.
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Your answer
Please give details of any current, or previous injuries. *Please include approximate date*
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Your answer
Please give details of any operations you have had, or are intending to have in the near future. *Please include approximate date*
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Your answer
Please give details of any concerns you have about specific body parts in terms of instability, reduced function or discomfort.
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Your answer
Do you know of any other reason why you should not engage in physical activity? If yes, please detail here.
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Your answer
What is the best time to call you to get you booked in?
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Your answer
I agree with ASC Performance Terms and Conditions as laid out on
ascperformance.com/terms-and-conditions
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I agree
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