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Jamie Stedman Personal Training Application Form
1. Please complete this form with as much detail as possible
2. We will respond within the next 48 hours, look out for a call/message from 07815509874 which is myself Jamie Stedman
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Email
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Best time to call for a chat?
More Info About You
Please complete with as much detail as required
Medical Stuff
Major injuries or illness, medication, allergies, bone or joint problems and anything else which would affect your ability to exercise
Physical Activity Readiness Questionnaire (tick each box that applies to you) *remember none of this will stop you starting, we just need to be aware*
Has a doctor ever said that you have a heart condition and recommended only medical supervised physical activity?
Do you ever have chest pain brought on by physical activity?
Do you tend to lose consciousness or fall over as a result of dizziness?
Has your doctor ever recommended medication for your blood pressure or heart condition?
Do you have a bone or joint problem that could be aggravated by the proposed physical activity?
Is there a good physical reason not mentioned here why you should not start exercising even if you wanted to?
Are you over 65 and not accustomed to moderate exercise?
I have No health problems or medical conditions that I'm aware of and I want to start exercising
If you answered YES to one or more of the questions… (besides the last one)
Please don't worry we are trained to deal with a wide variety of medical conditions and can best manage you.
If you answered NO to ALL of the questions (and yes to the last one) and answered the questions accurately you should have a reasonable assurance of your suitability for exercise.
Exercise History - please tick one
I currently do not exercise or walk on a regular basis
I currently do not exercise or walk on a regular basis but am going to start
During the last month, I have started to exercise or walk on occasion
I have been exercising for the last 1-6 months
I have been exercising for more than six months
What is your main reasons for wanting to start?
Fitness
Weight loss
Toning
Health
Strength
Flexibility/Mobility/Balance
Injury Rehabilitation/Prevention
Sport/event training
Other
Tick all that apply
Tell me a little bit more about your goal (why, when)
What has stopped you achieving this in the past?
Illness
Injury
Lack of will power
Lack of energy
You hate exercise/gyms/etc
Lack of time
Embarrassment
Not knowing what to do
Other
Tick all that apply
Please write a little bit more information about what has stopped you from achieving your goal in the past
Have you tried any of these in the past?
Gym
Fitness classes (zumba, circuits, boxercise etc)
Running
Cycling
Swimming
Walking
Personal trainer
Bootcamp
Weight Watchers/slimmming world/similar
Diets
Weight loss pills
Shakes & bars
Other
Tick all that apply
What type of training program interests you the most?
One-One Training
Small Group Training (3-4 people)
Buddy Training (pairs)
Fast Fitness (30 min sessions)
Which location do you wish to train at?
Private Studio in Bynea
Outdoor sessions (available on request)
What Duration Of Programme Would You Like? Visit http://www.personaltrainerllanelli.co.uk/one-one-group-training/ for more details
Signature Monthly Membership
12 Week Body Transformation
Small group training monthly membership
If applicable/accepted which days and times would you be able to train on each week? (two-three 30-45 minute sessions on non consecutive days). I work from 6am-8pm on Mon-Fri. If you need flexibility like many of my clients due to childcare/shift work write "flexi".
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