Health & Fitness Assessment

Welcome! Before we kick things off, we'd love to learn a little about you and your health. This helps us design a safe, effective program that's built around you. It should take about 5–10 minutes to complete.

Personal Information

What's your full name?

Date of birth:

Phone number:

Email address:

Emergency contact name & phone:

Body Measurements

Height (cm or ft/in):

Weight (kg or lbs):

Medical History

Do you have any of the following conditions? (Check all that apply)

Heart condition

High blood pressure

Diabetes

Asthma

Joint problems

Back problems

Recent surgery

Pregnancy

None of the above

Please describe any conditions checked above:

Current medications (if any):

Any injuries or areas of chronic pain we should know about?

Current Activity Level

How active are you right now? (Choose one)

Sedentary (little to no regular exercise)

Lightly active (1–2x per week)

Moderately active (3–4x per week)

Very active (5+ times per week)

Exercise Experience

How would you describe your fitness experience? (Choose one)

Complete beginner — this is all new to me

Some experience — I know the basics

Intermediate — comfortable with most exercises

Advanced — experienced and self-directed

Activities You Enjoy

Which of these activities do you enjoy or want to try? (Check all that apply)

Running

Swimming

Cycling

Weight training

Yoga / Pilates

Team sports

Dance

Hiking

None yet — I'm open to suggestions!

Doctor's Clearance

Have you received clearance from a doctor to exercise?

Yes — I've been cleared to exercise

No — I haven't checked with a doctor

I need to check — I will do so before starting

Declaration

I confirm that the information above is accurate and complete to the best of my knowledge.

Thanks for taking the time to fill this in! We'll review your details and be in touch shortly to get you started on your fitness journey.

Health & Fitness Assessment

Personal Information

Body Measurements

Medical History

Current Activity Level

Exercise Experience

Activities You Enjoy

Doctor's Clearance

Declaration

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