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Pre-exercise questionnaire


Fields marked * are required

Section A
Personal information
Section B

Please select Yes or No for each question below

Section C
Medical History
Section D
Informed Consent

My Participation in any fitness training programme with Barry Stephen Personal Training is voluntary. The information I have given is correct to the best of my knowledge. Apart from any conditions previously mentioned, I am in good physical condition, capable of performing active or passive exercise without detriment to my health, safety or physical comfort.

PERSONAL TRAINING sessions consist of activities that are designed to gradually improve the efficiency with which the body functions, but no guarantee of improvements can be made. Exercise levels will be progressive and be regulated by the trainer. During the training sessions, and for a period after, you may experience local muscular soreness and some fatigue. These minor discomforts very often disappear within 48 hours.

The reaction of the body to such activities cannot always be predicted. There are risks during or following exercise. These include abnormalities of blood pressure, heart rate or in very rare cases cardiac complications. Should you feel unwell or unsure please let the trainer know immediately. Every effort will be made to avoid any adverse reaction. Your trainer is a qualified First Aider and trained in CPR (emergency resuscitation) and is aware of emergency procedures to minimise the risk of any unexpected events should they occur. A doctor will not be present during the sessions and is not available through your trainer.

All information acquired during Personal Training sessions will be treated with the strictest confidentiality. You are free to stop your session at any time.

Please make sure before signing this form that all your questions have been answered. Take as much time as you deem necessary, and if you wish, discuss your participation with your doctor.