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Pre Exercise Questionaire

Please complete the following questionaire to the best of your ability before beginning any exercise program or personal training with ProActive. All your answers are confidential, and you may leave blank any questions you do not wish to answer. Please answer in as much detail as possible, so we can give you the best possible service.

If we have any doubts about your ability to exercise safely, we may recommend you obtain a medical clearence before beginning a new exercise program.

* Required fields
Name *
E-mail Address *
Contact Telephone *
Age:
Do you suffer from neck or back pain?
Do you experience frequent headaches?
Do you experience faintness or dizziness while exercising?
Are you pregnant?
Do you have high blood pressure?
Do you have high cholesterol?
Are you diabetic?
Are you asthmatic?
Do you have osteoporosis?
Do you have osteoarthritis?
If yes, what joints are affected?
Do you have any other type of arthritis?
If yes, please elaborate
Do you suffer from any recurrent or chronic injuries?
If yes, please elaborate
Have you ever had a heart attack?
If yes, please elaborate
Have you ever had a stroke?
If yes, please elaborate
Do you smoke?
Please list any medications or supplements you currently take, and their purpose
Please give a brief description of your current exercise routine
Please give a detailed description of the exercise equipment you have available to use
What would you like to achieve from your exercise program?
Is there anything not previously mentioned that might restrict or affect your exercise routine?

I have read and agree to the Privacy Policy *

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Once you have completed this questionnaire one of our trainers will be in touch to arrange your first training session.