Your Name (required)
Your DOB (required)
Your Email (required)
House/Flat Number/Name (required)
Indicate your reasons for choosing Online Coaching:
What are your main reasons for starting a fitness programme?
Other? Please give further info:
How would you describe your current general health and fitness?
Very badBadAverage UntrainedAverage TrainedTrainedGoodAthlete
Have you done any structured exercise before?
If yes, what did you do?
What did you enjoy the most?
What did you dislike / least enjoy?
What did you find easy?
What did you find most challenging?
What would you say are the main barriers to you from structuring your exercise plan?
Lack of facilities
Lack of Knowledge
How many sessions are you willing to commit to a week?
Home Sessions | Gym Sessions
If doing gym sessions, please state which gym:
Roughly how long to do you want each training session to be?
Are you planning to do any other exercise outside of this workout plan?
If yes, please give as much detail as you can (day, time, duration and type of exercise - i.e. circuit class, outdoor run, treadmill session, spin class)
Have access to
Willing to use
Never UsedNot confidentConfident User
Never UsedNot confidentConfident User
Please list any other equipment you have access to:
You should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.
Please read each question carefully and answer honestly by indicating YES or NO.
Have you had a major illness or injury in the last 5 years?
YesNo - If yes, please give details:
Are you receiving treatment for any diagnosed medical condition?
Are you taking any prescription medication?
Do you ever get unusually short of breath with very light exertion?
Do you ever have pain, pressure, heaviness or tightness in the chest area?
Do you regularly have unexplained pain in the abdomen, shoulders or arm?
Do you know of any other reason why you should not take part in physical activity?
Please indicate if you have ever experienced any of the following symptoms/
Ever have severe dizzy spells or episodes of fainting?
Regularly get lower leg pain during walking that is relieved by rest?
Ever experience palpitations or irregular heartbeats?
Are you currently pregnant or have you given birth in the last 6 months?
Do you experience aches, pains and problems in any specific areas:
e.g. "I always get knee pain when running"
I understand that when undertaking a new exercise regime I need to ensure I am physically fit and that I should check with my doctor first if I answer yes to any of the following questions
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had a chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem ( for example back, knee or hip) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
If YES Please further info:
I confirm that I have answered all questions honestly & the information given is correct.
I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury
I understand that by submitting this form I am committing to paying for and undertaking Online Coaching provided by Forza Fitness and that no plan will be released until my payment has been received.
Sign (Please type name/initials): (required)
Date Signed: (required)
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