top of page

30 DAY TRIAL FORM

Please fill out the form below and look forward to hearing from one of our team!

PERSONAL DETAILS

MEDICAL HISTORY

Have you ever been told you have a heart condition?
Do you have unexplained pains in your chest during rest or physical activity?
Do you suffer from asthma and require medication?
Do you suffer from type I or type II Diabetes?
Do you have any muscle or joint injury that may limit or become aggravated by physical activity?
Do you suffer from any medical condition that could be made worse by exercise?
Do you often feel faint or suffer from dizziness?
Do you suffer from clinically high blood pressure (>140/90)?
Are you pregnant / post natal?
Have you had a recent operation / illness?
Do you know of any other reason why you should not exercise or increase your physical activity?

LIFESTYLE

Do you smoke?
In an average week, how many alcoholic drinks do you consume?
How do you consider your current nutrition?
How do you consider your current stress levels?
On average, how many times do you currently participate in physical activity each week?
On average, how many hours sleep do you get per night?

GOALS AND OBJECTIVES

DECLARATION

Please submit this form then proceed to payment

Thanks for submitting!

bottom of page