Hello and Welcome.
This is your first step to achieving your goals, the questions will take a minutes or two to answer but it is worth it, your health is worth it. this form will be remain confidential between yourself and your Fit To Excel Trainer. It is important to answer the health questions honestly as it is for your safety and well being. On your first session with your trainer they will sit down and go through your goals and health concerns with you in more detail. If you would prefer to do this whole process in person please just click here to let us know that.

* Required

Title DR MISS MR MRS MS

First Name *

Last Name *

Email Address *

Date of Birth *

Home Address *

City *

State *

Zipcode/Postcode *

Country * -- Select Country -- AFGHANISTAN ALAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CâTE D'IVOIRE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES UNITED STATES MINOR OUTLYING ISLANDS URUGUAY UZBEKISTAN VANUATU VENEZUELA VIETNAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE

Home Phone Number *

Work Phone Number *

Cell Phone Number *

Enter Word Verification in box below *

Who was the Trainer you were interested in training with? * Thomas Nadine Dan E Ben Lea Dan D Christine

How Did you hear about Fit To Excel? * From a friend From the PCYC Mountain Bike or Cycling Event Cycling Shop or From Google Other

Who was the friend that recommended you?

Was fit2excel.com.au easy to find? * Yes No

Is your occupation * Very active Active Non active

What are your favourite exercises? *

What are the not so favourite excercises? *

What sports are you currently involved in?

What sports were you envolved in?

What sports would you like to become involved in?

What are your health and fitness goals? * Get fitter Get faster Get stronger Get smaller Get BIGGER Get healthier Rehabiliation Better Quality of life

What are your five top specific goals you want to achieve? Starting with your No. 1 goal. *

No. 2

No. 3

No. 4

No. 5

How do you currently feel about your health? * Great Good Average Poor

How do you currently feel about your fitness? * Great Good Average Poor

Do you have plenty of energy * Yes No

When do you want to achieve this goal by? *

Why do you want to achieve this goal *

If you continue to do what you do currently will you achieve your goal? * Yes No

What are you prepared to do to achieve your goal? *

What do you expect from your trainer? *

What days can you train? * Monday Tuesday Wednesday Thursday Friday Saturday Sunday

What time of the day suits you best? * 6am-8am 8am-12pm 12pm-4pm 4pm onwards

How many days do you currently exercise? *

What exercise do you do on Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Do you have any medical conditions that may prevent you from exercising * Yes No

Do you have any of the following conditions * Asthma Epilepsy Diabetes Dizziness Chest Pain High Cholesterol Arthritis Osteoporosis Heart Problems Nothing To Report Here

Do Have high or Low blood pressure * High Low Normal Unsure

My Last bloodpressure reading was

Please comment on any of your conditions here.

Do have any joint pains or injuries past or present? * Ankles Knees Hips Back Shoulders Neck Elbows Wrists Hands Fingers Nothing to Report

Please comment on any of you conditions here.

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