Let’s work together Name * First Name Last Name Email * Phone (###) ### #### Preferred Contact Time(s) What services are you interested in? Personal Training Run Coaching Personal Training and Run Coaching Circuit Training Nutrition Advice How did you hear about us? Online Search Recommended by Friend / Family Other Message * PAR-Q form Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? Yes No Do you feel pain in your chest when you do physical activity? Yes No In the past month, have you had chest pain when you were not doing physical activity? Yes No Do you lose your balance because of dizziness or do you ever lose consciousness? Yes No Do you have a bone or joint problem (e.g. back, knee or hip) that could be made worse by a change in your physical activity levels? Yes No Is your doctor currently prescribing drugs for for your blood pressure or heart condition? Yes No Do you know of any other reason why you should not do physical activity? Yes No If you have answered yes to any of these questions, please give details. Thank you for selecting me to work with you!I will be in touch soon with some more questions, so that I can help you reach your goals and design a programme that is tailored to you and your lifestyle.
