The information obtained during this fitness evaluation will be treated as confidential and will not be released or revealed to anyone without your consent. Your right to privacy is our prime concern.

Name *
Name
Date of Birth
Date of Birth
Sex
Emergency Contact Name
Emergency Contact Name
Medical Information
Have you ever had or currently have the following?
Are you male over 45 or female over 55 year and have not exercised in the past 12 months?
Are you pregnant, planning to become pregnant, or have given birth in the last 12 months?
Do you have any muscle, bone or joint pain or soreness that is made worse by particular types of activity?
Do you have a family history of heart disease, stroke or raised cholesterol of relatives under the age of 65?
Do you have any injuries that may hinder your participation in an exercise program?
Exercise
Is your occupation
Cardiovascular and weights program and date last attended.
10's and 20's
How would you describe your activity levels?
20's and 30's
How would you describe your activity levels?
30's and 40's
How would you describe your activity levels
40's and 50's
How would you describe your activity levels?
50's and 60's
How would you describe your activity levels?
60's and 70's
How would you describe your activity levels?
Diet
Include Times / Type of Food / Quantity
Include Times / Type of Food / Quantity
Include Times / Type of Food / Quantity
Include Times / Type of Food / Quantity
Include Times / Type of Food / Quantity
Include Times / Type of Food / Quantity
Goals
What are your goals?
Per Week
In Minutes
Approx 12 Months
Approx 6 Weeks
I am happy to receive promotional material from PhitKit Personal and Group Training (PhitKit) including training tips and notifications. *
Terms and Conditions *

To ensure your health and safety whilst participating in PhitKit exercise classes take a moment to reflect on your screening form, and sign below to confirm your responsibilities.

I understand that PhitKit Personal & Group Training trainers require full disclosure of my current and past health status to ensure a safe and effective exercise environment. I take responsibility for notifying PhitKit of my general health status and any other issues relating to my health and ability to participate in an exercise program.

I agree to inform PhitKit Personal and Group Training and the Trainers all relevant information and will keep PhitKit Personal and Group Training and the Trainers informed of any changes to my health status. I understand that PhitKit Personal and Group Training and the Trainers are not able to provide me with medical advice with regard to any medical conditions I may have and that this information is used only as a guideline to the limitations of my ability to exercise.

I realise that exercising does present an element of risk to injury, including, but not limited to; sprains, strains, discomfort in breathing, dizziness and heart attack.

I will and agree to inform my trainer at all times should I not feel comfortable with any exercise or experience any discomfort.

I will not hold PhitKit Personal and Group Training or the Trainers liable for any injuries that may occur while I am training.

I understand and accept these conditions and acknowledge that there is risk and accept and agree that I will be participating at my own risk.