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Sign Up

SIGN UP

Thank you for deciding to use our service.

You are one step closer to improving your overall fitness and health goals. Our process forms part of the consult including the sign-up form.

The information that you provide is very important, once you have completed and we have received your information, we will be in contact to discuss any information you may provide, then we can sort and discuss your first session.

As part of this sign-up process, it is very important that you read through the terms and conditions so that you understand the client/trainer relationship.

This also acts as your acceptance to be trained by MD Fitness.

Most of all, have fun with your journey.


FemaleMale

Family History

This section will provide important information that will help when prescribing and designing a fitness plan that suits you. Family history only gives us an indication of what things we can help prevent in the future.

Personal and/or family illnesses


DiabetesHeart problemsChest painArthritisHigh blood pressureLow blood pressureEpilepsyStrokeOsteoporosisAsthmaHigh cholesterolNone



YesNo


YesNo


YesNo



HeadArmsLower LegsNeckHands/WristsAnkles/FeetBackHipsElbowTorsoUpper LegsShouldersKneesOtherNone


YesNoSometimesNothing I can't handleMinor Mobility Issues



Blood Pressure (BP)

Normal Range is between 110/70-120/80


HeadachesNosebleedsShortness of breathDecreased pain responseVision problemsIrregular heartbeatOther

Physical Profile

This information will help MD Fitness design the best plan for you. We are with you all the way!

Goals

We will work together to reach your goals!

Your Personal Goal Statement

What is this? These are your own words to keep you accountable to yourself. I use the statement you provide to remind you of your reason for why! Example Goal: I am getting married, I want to look my best on my wedding day - push me hard!


Get fitterGet strongerBuild muscleLose body fatI want to be competition ready


Not verySomewhatVeryExtremelyI am ready and fully committedHelp me, it's life or death


I am self-motivatedI find exercise easier to stick to if I have a partnerI find exercise easier with regular appointmentsI usually experience some problems staying motivatedI need constant motivation


FamilyFriendsWork colleagues

Two rest days are advisable, however, this will be dependant on your goals as we encourage some type of physical exercise on rest days, this may even mean going for a simple walk.

1-2 days2-3 days3-4 days4-5 days5-6 daysMonday through to Friday


Muscular workoutsCardiovascular workoutsFunctional FitOnly with a PTOther

Please explain what sort of training progamme you had in mind if you selected other above


30 mins45 mins60 mins


1234567 I will push you8 You will be working at almost max9 Pretty Intense10 Super Athlete


Terms and Conditions

Please make sure that you read our terms and conditions. Tick the accept form on the terms and conditions page after submitting this form.

By ticking this box I accept this agreement in the waiver of my signature (required)

I agree and accept that I have read the T&C's and understand themI am still considering this services and do not currently accept the T&C's at this point.

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