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PERSONAL TRAINING

If you would like to purchase a PT package please fill out the below form and select either the Gold or Platinum package. Select the package that applies to you; either new or current client. We will then contact you to book in your sessions.

Medical Questionnaire

Please fill out the below prior to purchasing HealThy Self Exercise Physiology's exercise videos. Once you have completed this form, click the start exercising button below!

First Name

Email Address

Last Name

Date of Birth

Have you ever been told you have a heart condition, experienced a stroke or unexplained chest pain?

Yes

Do you ever feel faint or dizzy? Have you had an asthma attack requiring immediate medical attention in that last 12 months? Do you have Diabetes?

Yes

Do you have any muscle, joint or bone problems that you’ve been told could be made worse with exercise? Do you have any other conditions?

Yes

I declare that the info I’ve provided is accurate & complete. If I have answered yes to any of the questions above, I will seek guidance from my GP or appropriate allied health professional to undertaking exercise; including HealThy Self Exercise Physiology's online classes. You acknowledge that due to the physical nature of the online classes, that there is a risk during exercise of adverse changes including, but not limited to, abnormal blood pressure, fainting, dizziness, disorders of heart rhythm, and in very rare instances, heart attack, stroke or even death. You understand that if you feel dizzy or unwell during exercise, you must stop exercising. You acknowledge that your participation in the online classes is voluntary.

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PERSONAL TRAINING

Medical Questionnaire

Monday - Thursday

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