The Sweat Shop - Group Fitness and PT

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Thank you for registering with The Sweat Shop - we're excited to have you join us!.

We want you to have a safe, enjoyable and effective workout every time, but all exercise comes with some degree of risk of injury. To help minimise this risk and to get to know your needs better, your completion of the Health and Fitness Pre-screening Assessment below would be much appreciated.

All answers will remain strictly confidential and will only be reviewed by Anna Liguori of The Sweat Shop.

Email *

Full name and contact number *

Date of birth *

YYYY

Emergency Contact Name & Number *

COVID- 19 - A quick reminder:

If you have flu-like symptoms such as fever, headache, cough, shortness of breath or sore throat you cannot train today and are advised to isolate at home

Yes

Required

If you have had Covid19 recently or in the past..

please state the date(s) and describe your degree of illness/recovery? (As research shows, this could affect your capacity to increase training, particularly with long-Covid symptoms.)

HEALTH & FITNESS PRE-SCREENING

Why do you want to work with a personal trainer and/or join a group fitness class? *

What are your health and fitness goals? *

Improve general fitness

Get stronger

Gain muscle

Improve posture

Improve flexibility

Decrease body fat

Lose weight

Tone up

Sleep Better

Mange stress

Improve mental health

Post-natal core rehab and/or return to exercise

Other:

Required

Do you have a specific goal in mind (ie. Tone up for August wedding in Fiji or run 10km in May)? Describe *

What do you see as your biggest barriers to achieving your goal(s)? *

What are your current activity levels like? *

I agree to discuss with my fitness instructor any of the below conditions I have, which may impact my ability to exercise and/or require exercise modifications. *

A heart condition

Suffered a stroke

Diabetes - Type 1 or 2

Arthritis

Asthma

High blood pressure

High cholesterol

Epilepsy

Osteoporosis

Endometriosis

Do you ever get chest pains?

Do you ever feel dizzy or faint?

Smoker

Family history of heart disease such as stroke or heart attack?

Spent time in hospital (including day admission) for any medical condition/illness/injury/operation during the last 12 months?

Taking medication(s) for any medical conditions(s)?

Pregnant, recently been pregnant or given birth

Going through or been through menopause

Have abdominal separation from pregnancy or other cause

Women: Have pelvic floor dysfunction (leakage, tear, prolapse, pain) from pregnancy, birth, menopause

Men & Women: Have pelvic floor dysfunction (as above) from: high impact sports, trauma, surgery, chronic bowel conditions.

Have had pelvic floor or abdominal surgery.

None

Other:

Required

If you have ticked any of the medical conditions above, please provide detail below (ie. seeing a pelvic floor physio for diastasis recti rehab since X).

Your fitness instructor may wish to discuss your management of these conditions and any exercise modifications required.

Do you have any injuries or issues with joints or muscles in the following areas? *

Ankles

Knees

Hips

Back

Shoulders

Neck

Elbows

Wrists

Other

None

Required

If you answered yes to any of the questions above, please provide details.

Informed Consent and Terms & Conditions

This screening tool does not provide advice on a particular matter, nor does it substitute for advice from an appropriately qualified medical professional. No warranty of safety should result from its use. This screening system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by The Sweat Shop or Anna Liguori – Personal Trainer for any loss, damage or injury that may arise from any person acting on any statement or information contained in this tool.

I hereby acknowledge that the information provided above regarding my health is, to the best of my knowledge, correct. I will inform my trainer immediately if there are any changes to my health status.

By booking, I the participant acknowledge I am in reasonable physical condition and currently have no medical reason or physical impairment that will prevent my ability to participate safely. If you have any medical issues or physical impairments, please consult with your doctor or medical professional first.

Participants must at all times follow the instructions and advice of the Instructor; and act with courtesy and and respect to the instructor and other participants. Failure to do so may result in the Instructor requiring an attendee to immediately leave the session and/or exclusion from future sessions. All attendees acknowledge and agree to the terms set out in this clause and undertake to immediately leave if requested to do so.

I have read and agree to the above terms & conditions. I acknowledge that participating in physical activity carries a risk and I accept all responsibility for that risk. *

I agree

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