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  5. New Client Questionnaire
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Exit Survey
 
Contact Information
First Name : 
Last Name : 
Phone : 
Email Address : 
 
 
 
Date of birth
   
 
 
 
Height (cm)
   
 
 
 
Weight
   
 
 
 
Gender
   
 
 
 
Occupation
   
 
 
 
Do you consider your self relatively healthy and able to undertake a training regime?
 
Yes
 
No

 
 
 
Has a medical professional ever advised that you do NOT undergo exercise?
 
Yes
 
No

 
 
 
Do you have any limiting factors to consider when you workout (disability or other condition)?
 
Yes
 
No

 
 
 
If yes please give details: