Personal Training Screening Form

If you are pregnant or have recently had a baby please complete the pregnancy or postnatal screening form

Name

Occupation

Date of Birth

Mobile

Email

Address

Emergency Contact (Name & Number)

What are your main goals, aims or reasons for starting with FemmeBods?

Prior to joining Femmebods have you been doing any regular exercise? Please give details below

How would you describe your nutrition?

How well do you sleep? Also please give an indication of hours per night.

GENERAL HEALTH - Do you have any of the following?

Are you or have you been seeing a health practitioner for any injuries, illness or muscle soreness

Heart condition

Chest pain when exercising

Loss of balance due to dizziness

Back, Pelvic or other joint pain that could be made worse by exercise

High or low blood pressure

High cholesterol

Diabetes

Epilepsy or a history of fits

Asthma

Constipation/IBS/Coeliac or Crohn's disease

Current or previous eating disorder

If you have selected any of the above, please provide details here

Have you had any major surgeries or other physical trauma?

Are you pregnant or have you recently had a baby?

Do you have children? If so, what age are they?

Do you have issues with any of the following:

Current of previous pelvic floor issues

Current or previous urinary issues

Current or previous bowel issues

Diastasis Recti (separation of the abdominal muscles)

Cesarean scar pain or discomfort

If you have selected any of the above, please provide details here

Are you taking any medication? If so, please specify

Do you smoke? If so, how much?

Anything I have missed that you think is important for me to know

I, the client have answered the above questions truthfully to the best of my knowledge. If there are any changes to my health I will inform my trainer.

During exercise sessions every effort is made to keep the session safe and minimise risks whilst providing an effective session. I, the client, am participating of my own free will and am aware, as with any exercise programme, there is a risk of injury. If I am feeling any discomfort or uncertainty throughout a session I will stop immediately and consult the trainer. I will not hold Femme Bods or staff liable in any way for injuries or illness that may occur while I am training.

I understand that occasionally photographs will be taken for advertising and promotion. I am happy for pictures of me to be used for these purposes.

I have read the Terms & Conditions, if not, please do so now at https://www.femmebods.nz/personal-training-terms-and-conditions/

Best time and method to contact you

Address

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Personal Training Screening Form

*If you are pregnant or have recently had a baby please complete the pregnancy or postnatal screening form*

I'm here to help

If you are pregnant or have recently had a baby please complete the pregnancy or postnatal screening form