Please use this form to email your personal details either for Personal Training services or for your Free NordicFit Classes. This will help to assess your fitness requirements at your initial consultation . Your details are strictly confidential and will never be shared with anyone else or used for marketing purposes.
Your Contact Details
Name:
Email Address:
Street Address:
City:
State:
Postcode / Zip:
Home Phone Number:
Business Phone Number:
Fax Number:
Your Personal Information
Date of Birth:
Age:
Sex:
Height (cm):
Your present weight:
Weight (12 months ago):
Weight (at 21 yrs of age):
Your Physical Condition
Do you have any physical or medical conditions that would limit you from engaging in a safe exercise program?:
If yes, please indicate why ...
(include any surgery you may have had):
Your Lifestyle
Your current occupation:
How many hours do you work per week?:
How do you spend most of your time at work?:
Do you smoke?:
If yes, how many per day?:
Indicate your daily stress level on a scale of 1-10
(10 being very stressed):
Indicate your energy level on a scale of 1-10
(1 being low energy):
Your Physical Activity
What is your favourite physical activity?:
How often do you do this?:
How many times per week do you engage in moderate or strenuous exercise for at least 20 minutes?:
If yes, describe what you do:
How long have you been doing this?:
Have you ever begun an exercise program and then stopped?:
If yes, why did you stop?:
Your Workout Availability
How many times per week do you plan to train?:
Please indicate your preferred times and days
you wish to train:
Please provide a day and time that is convenient for you to schedule your initial Fitness consultation:
Please provide an alternative day and time:
What would you like to achieve in a fitness program? (anything specific?):
In order to design a training program that would best suit your needs, please indicate what you are looking for in a personal trainer:
Check any of the services/activities that interest you:

Strength and Fitness Training
Rehabilitation Supervising
Weight Management
Body Building
Sports Conditioning
Nutritional Counseling
Pre-Post Natal Therapy

Nordic Pole Walking
Where have you heard about BodySublime.com:
Comments:

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