Name:

Member number:

Mobile:

Home:

Email:

Your personal health and fitness goals:

Short term goals (within two months):

Medium term goals (within six months):

Long term goals (one year and beyond):

Please mark the days
you would prefer to train:

What time would you prefer to train:

Number of sessions per week:

Preference for 30 or 60 minute sessions:

Provide a brief description of your exercise history within the last twelve months:

Do you have any exercise restrictions or previous injuries:

Have you worked with a personal trainer previously:

Would you prefer a male or female trainer: