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NORTH LEEDS PERSONAL TRAINING GYM | ROUNDHAY | SHAPE CLUB
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NORTH LEEDS PERSONAL TRAINING GYM | ROUNDHAY | SHAPE CLUB
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PERSONAL TRAINING
MUMS SMALL GROUP PT
PRIVATE GYM ACCESS
TRANSFORMATIONS
CONTACT US
PT Consultation
Personal Details
Name
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First
Last
Gender
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Select
Male
Female
Mobile
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Address
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Street Address
Address Line 2
City
ZIP / Postal Code
Emergency Contact
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First
Last
Email
*
Occupation
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Age
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Date of Birth
*
MM slash DD slash YYYY
Favourite music
Favourite Snack
Personal Illnesses
Have you had any of the following?
Diabetes
Heart Problems
High / Low Blood Pressure
Stroke
Asthma
Chest pain
Arthritis
Epilepsy
Osteoporosis
High Cholesterol
No, I am all good
Other (write it down below)
Any other Problem?
Smoking
Do you smoke?
*
Yes
No
Have you ever smoked?
*
Yes
No
If you stopped smoking, how long ago did you stop?
Medications
Do you take any pills, tablets, medicine or medication?
*
Yes
No
Please state them here.
Injury Profile
Have you ever injured any of the following areas of your body?
*
Head
Neck
Back
Torso
Shoulders
Arms
Hands / wrists
Hips
Upper legs
Knees
Lower legs
Ankles / feet
Is there anything else that may affect you exercising?
Physical profile
Weight
Pant/dress size
Goals
I want to...
*
Get fitter
Get stronger
Build muscle
Lose body fat
I want to feel...
*
More awake
Healthier
More relaxed
More in control
I want to have...
*
More time
Less stress
More energy
More fun
Commitment
How important to you is it that you achieve the goals above?
*
Not very
Somewhat
Very
Extremely
What areas are you willing to work on to achieve these goal(s)?
*
Exercise
Nutrition
Stress/Mood
In your experience which phrase best describes your motivation levels?
*
I am self motivated
I find exercise easier to stick to if I have a partner
I find exercise easier with regular appointments
I usually experience some problems staying motivated
I need constant motivation
Support
Family
Yes
No
Friends
Yes
No
Work colleagues
Yes
No
What are you expecting from your Personal Trainer?
Exercise Preferences
What activities are you doing?
What do you like about them?
2. If you have previously exercised…
What activities did you do?
What did you like about them?
Was there anything you didn’t like about them?
On average, how hard would you like to exercise (on average from 1 – 10, 10 being extremely hard)?
Phone
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Name
*
First
Last
Email
*
Mobile Number
*
Gender
*
Male
Male
Female
What are you interested in?
*
1:1 PT MEMBERSHIP
1:1 PT MEMBERSHIP
1:1 6 WEEKS TRANSFORMATION
1:1 SHAPE IT IN 12 WEEKS
TRAIN IN PAIRS (PARTNER/FRIEND)
SMALL GROUP PT (UP TO 6 MEMBERS)
Gender of the trainer?
*
MALE
MALE
FEMALE
DOESN'T MATTER
Book your free consultation?
Yes, I'm interested in a free consultation
Message
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How did you hear about us?
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