tekniQ training | West Hoxton | outdoor training

Before you get started there are a few things we need to know about you.

Personal Information

Name

First Name

Last Name

Date of Birth

Current Age

Address

Phone Number

Occupation

Emergency Contact Name

Emergency Contact Number

Tick this box to let us know we can take a photo of you for future reference, that way we can SEE your progress!

I agree

Your Goals

What is your number one fitness goal?

What is your timeframe for achieving this goal?

How many days a week can you dedicate to this goal?

One

Two

Three

Four

Five

Six

Seven

How will you feel if you do NOT achieve this goal?

How will you feel if you DO achieve this goal?

What type of training do you prefer?

Select from below

Technique/Demonstrated

Tough Love

Motivational

Easy

Educational

Fun

Military/Bootcamp

Medical History

Is there anything in your medical history that we need to know about?

Assessing your health needs

Have you ever experienced the following?

Please tick boxes

A heart attack

Heart surgery

A pacemaker

Health failure

A heart transplant

Congenital heart disease

Are you pregnant

Are you trying to conceive?

Do you experience the following symptoms?

Chest discomfort with exertion

Unreasonable breathlessness

Dizziness, fainting, blackouts

Do you take prescription medication?

If yes, what are they?

Do you take heart medication?

If yes, what are they?

Other personal details

Are you male, over 45 years?

Are you postmenopausal?

Are you a smoker?

Do you take BP mediation?

History of heart attacks in your family?

Are you diabetic?

Are you physically inactive?

Do you suffer from epilepsy?

Do you have asthma?

If you marked YES to two or more questions in this section you may have to visit an allied health professional or medical practitioner before commencing an exercise program. If you did not, then that’s awesome! You are a picture of health and we can get on with achieving your goals immediately!!

Medical History

Do you have any joint problems, aches or pains or old injuries we need to know about that may affect your training?

If yes, please explain?

Do you have medical clearance for any of the above?

How fit are you?

Please rate your ability level in the following areas from 1 to 10. 1 being little to no ability, 10 being great ability.

Fitness

Strength

Flexibility

Endurance

In a brief statement, describe how you FEEL about your health and well being. Be honest with yourself