Personal Trainer Armadale

Health Form


  • DD slash MM slash YYYY
  • Emergency Contact Person

  • Current Exercise

  • Exercise Goals

    List your 3 main health & fitness goals in order of priority (please be as specific as possible)
  • Health History

  • Medical Conditions

  • YesNo
    1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
    2. Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?
    3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
    4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
    5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?
    6. Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?
    7. Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?
  • IF YOU ANSWERED ‘YES’ to any of these 7 questions, please seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity.
  • Other medical details

  • Terms & Conditions

    • All sessions must be paid for in full before being undertaken. Payments are made fortnightly via direct debit.
    • At least 24 hours’ notice is required to cancel a session (for a make-up session to be granted).
    • Please bring a water bottle and large towel to each session. Towels are to be used on equipment and mats in gym.
    • Please read full list of Terms & Conditions which is provided to all clients in their Introductory Pack
    *PREGNANCY: If you become pregnant, please notify EverMotion as soon as possible as special considerations need to be taken. It is also wise to wait at least six weeks after birth before resuming exercise (however, please consult your medical practitioner before resuming).

    To the best of my knowledge I have provided all the relevant information that may affect my ability to exercise. I take full responsibility for my actions at all times during workouts with EverMotion and while on the premises. I understand and accept the cancellation policy.
  • MM slash DD slash YYYY
  • If you have any questions please email us at [email protected] or call 0417 030 751.