Personal Details

First Name

Last Name

Phone *

Date of birth

Emergency Contact Number

Emergency Contact Name

Medical Screening (PAR-Q)

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 doing physical activity?

Have you had chest pain when not doing physical activity in the past month?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem that could be worsened by a change in physical activity?

Is your doctor currently prescribing medication for your blood pressure or heart condition?

Do you know of any other reason why you should not do physical activity?

Medical Screening Details

Health & Lifestyle Information

Height (cm)

Weight (kg)

How would you rate your stress level (1 = Low, 10 = Very High)?

Do you currently smoke?

Do you drink alcohol regularly?

Do you have any current or past injuries or health conditions we should be aware of?

What Supplements are you currently taking?

What Medication are you currently taking?

Goals & Fitness Background

What is your main fitness goal?

Other Fitness Goals

How many days per week are you currently active?

What types of exercise do you currently enjoy or have experience with?

Types of exercise Details

Do you follow a specific diet or eating pattern? If yes, please describe.

Informed Consent & Agreement

I confirm that the information I’ve provided is accurate to the best of my knowledge.
I understand that I should consult my physician before beginning any new exercise program.
I voluntarily agree to participate and release to personal trainer Dennis Oh Weng Kian from any liability related to my participation.

Date Picker 1ceq

Digital Signature

Clear

I agree to the terms above *

I agree