121 Questionnaire - Switch Fitness Personal Training

Do you smoke?

No0-10 per day11-15 per day16-20 per dayover 20 per day

Do you drink?

No0-10 units per week11-20 units per weekOver 20 units per week

Hours sleep per night?

Hours spent seated per day

Describe your stress levels

Not stressed at allOccasionally get stressedStressed at least once a weekFeel stressed on a daily basis

Previous Personal Trainer?

Please give details of any personal training, either 1-2-1 or online that you have received previously.

Medical Conditions:

Please detail ALL injuries, accidents and medical treatments you have received including dates, causes, medical treatment, prognosis and current condition. In addition please detail ANYTHING you feel may be a consideration in an exercise program, paying particular attention to activities or movements that cause you pain. Also include any areas on your body where you suffer tightness, soreness, numbness, tingling or stabbing pains.

Current fitness levels?

Very unfitUnfitFitVery fit

Current Exercise

Please detail all your current weekly exercise. Include classes, team sports and gym work. Include length of time and intensity.

Have you ever been told by a medical professional not to exercise?

YesNo

Please give further information if you ticked 'yes' above

Pain

Have you felt any unexplained pain in the last month or do you experience pain when exercising, in particular in your chest?YesNo

Pain Details

Please give further details if applicable

Personal Details

Your Lifestyle

Your Requirements

Your Commitment

The Business Bit

Training Agreement

Verification