*Not available until September 2018!

Hi there! I’m so excited for you to join me on this online personal training adventure!  
Please fill out this form so we can get started promptly. For more information about the training, click here

All information that you share with us will be kept strictly confidential.

Name *
I'm a *
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
2. Do you feel pain in your chest when you do physical activity? *
3. In the past month, have you had chest pain when you were not doing physical activity? *
4. Do you lose your balance because of dizziness, or do you ever lose consciousness? *
5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? *
6. Is your doctor currently prescribing drugs for your blood pressure or heart condition? *
7. Do you know of any other reason why you should not do physical activity? *
PLEASE NOTE: If your health changes so that you then answer YES to any of the above questions, tell your health professional, stop doing this program and inform me as soon as possible by email: ourfitfamilylife@gmail.com *
5. Do you partake in any recreational activities (golf, tennis, skiing, etc.)? (If yes, please explain.) *
6. Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc.)? (If yes, please explain.) *
7. Have you ever had any surgeries? (If yes, please explain and provide the date.) *
8. Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol or diabetes? (If yes, please explain.) *
9. Are you currently taking any medication? (If yes, please list.) *
10. Are you currently exercising? If so, can you describe in detail what your weekly exercise routine consists of (type of exercise, how many days a week & for how long)? *
12. Do you have any children? If yes, how old are they?
13. If you just had a baby, has your doctor given you the green light to start exercising ? *
14. Do you have a Diastasis Recti (abdominal separation after childbirth)?
Do you have a prolapse (it usually feels like having a tampon in your vagina, when there's nothing there)?
I willingly participate in the practical exercises at my own risk. I have no physical restrictions, disabilities or any predisposition to sickness or injury that may be aggravated or adversely affected as a result of my participation. I take full responsibility for any injury, loss or damage to my person or property that may arise directly or indirectly from my participation in the exercises. I will not seek to penalise, prosecute or claim compensation from the company for any injury, loss or damage. I agree to the statement above, and certify that the information I have provided in this form is accurate and applicable to me. *
Date *
Sign your name *
Sign your name

Thank you for taking the time to answer these questions, I'll be in touch with you very shortly.