First Name*
Last Name*
Instagram Account*
Email*
Phone Number*
Choose Birthday*
Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
Date
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PERSONAL DETAILS
Age*
Height*
Weight*
About you*
What is your current occupation*
What motivates you*
What is your goal in the next 6-12 months*
What are your body composition goals*
Which areas of your body do you want to target*
What is it you need from us to help you achieve your goals*
Are you going away on holiday any time soon*
How did you hear about us*
Have you used any other personal training or nutrition service*
What is your t-shirt size*
MENTAL HEALTH
Over the last four weeks how often have you been bothered by any of the following
Not being able to control worrying* No daysSome daysHalf the daysMore than half the daysNearly every day
Trouble relaxing and switching off* No daysSome daysHalf the daysMore than half the daysNearly every day
Becoming easily annoyed or irritated* No daysSome daysHalf the daysMore than half the daysNearly every day
Trouble sleeping, staying asleep or sleeping too much* No daysSome daysHalf the daysMore than half the daysNearly every day
Feeling down, depressed or hopeless* No daysSome daysHalf the daysMore than half the daysNearly every day
Little interest or pleasure in doing things* No daysSome daysHalf the daysMore than half the daysNearly every day
Thoughts that you may want to harm yourself or others* No daysSome daysHalf the daysMore than half the daysNearly every day
Has thinking about your shape or weight made it difficult to concentrate on things you are interested in* Not at allSlightlyModeratelyMarkedly
How many times in the last two weeks have you had a sense that you’ve lost control over your eating*
How confident do you feel in yourself? (10 being the highest confidence score, 5 being an average confidence score, and 1 being the lowest or no confidence score)* 12345678910
How confident do you feel in your body? (10 being the highest confidence score, 5 being an average confidence score, and 1 being the lowest or no confidence score)* 12345678910
GENERAL HEALTH
Do you have any injuries or restrictions*
Do you suffer from high or low blood pressure*
Do you experience high levels of stress on a regular basis*
Have you ever had an eating disorder*
Food allergies*
Any digestive problems*
Do you suffer or have suffered from any of the following conditions - Heart Disease - Stroke - Diabetes - High Cholesterol*
Do you take any medication or supplements*
Do you experience episodes of anxiety or depression - sometimes-always-never*
Can you describe your current sleep pattern*
DIET & NUTRITION INFO
Diet History*
Whats is your relationship with food like currently - Do you over or under eat*
How many calories are you currently on*
What do you eat and drink in an average day*
Do you eat very similar meals each day or are they varied*
How often do you eat*
Do you consume alcohol*
What are your nutritional weaknesses*
Foods to include*
What are your favourite snacks*
What are your preferred food dressings or sauces*
Foods to avoid*
Your weekly food shop budget*
DAILY ACTIVITY & TRAINING
Please give us a description of your average day*
Do you track your daily steps*
How active are you at work*
What is your training-exercise history*
What level would you class yourself at in training and exercise*
How often do you train currently*
When do you train*
Do you follow a current training routine or split*
What type of training do you prefer*
What type of cardio do you prefer*
What facilities are available*
Referral - Please provide the referring existing client's email. Otherwise, the referral cannot be tracked and the referring client won't receive the offer
Your Signature* [signature signature-305 color:#000000 backcolor:#dddddd height:200]
Terms and Conditions*
Terms and Conditions of TapoutFitness Gym 1. Membership 1.1. Eligibility: Membership is open to individuals aged 18 and above. Minors aged 14-17 may join with parental consent and must be supervised by a guardian during workouts. 1.2. Membership Types: Various membership plans are available, including monthly, annual, and family memberships. Details are provided at the time of registration. 1.3. Membership Fees: Fees must be paid in advance. All fees are non-refundable. Membership will be suspended or terminated for non-payment. 1.4. Membership Card: Members must present their membership card upon entering the gym. The card is non-transferable. 1.5. Termination and Suspension: The gym reserves the right to terminate or suspend membership for violation of rules or conduct that is deemed inappropriate or harmful. 2. Facility Use 2.1. Operating Hours: Operating hours are subject to change. Members will be notified of any changes in advance. 2.2. Equipment Use: Members are expected to use equipment properly and follow all posted instructions. Misuse of equipment may result in membership termination. 2.3. Locker Rooms: Lockers are available for daily use only. The gym is not responsible for lost or stolen items. 2.4. Personal Training: Only TapoutFitness trainers are permitted to conduct personal training sessions within the facility. 2.5. Classes and Programs: Class schedules are subject to change. Participation is on a first-come, first-served basis. Some classes may require prior registration. 3. Conduct 3.1. Behavior: Members are expected to behave respectfully towards staff and other members. Harassment, abuse, or disruptive behavior will not be tolerated. 3.2. Attire: Appropriate athletic attire and footwear must be worn at all times. No open-toed shoes are allowed. 3.3. Cleanliness: Members must wipe down equipment after use and dispose of trash properly. Personal hygiene must be maintained. 4. Health and Safety 4.1. Health Clearance: Members should consult a physician before beginning any exercise program. The gym is not responsible for any injury or health condition resulting from participation. 4.2. Accidents and Injuries: Any accidents or injuries must be reported to the staff immediately. The gym is not liable for any injuries sustained on the premises. 4.3. Emergency Procedures: Members must follow all emergency procedures and staff instructions during emergencies. 5. Privacy and Data 5.1. Personal Information: The gym collects and processes personal information in accordance with applicable laws. This information is used for membership management and communication. 5.2. Photography and Recording: Members must obtain prior consent before photographing or recording within the facility. 6. Amendments 6.1. Changes to Terms: TapoutFitness reserves the right to modify these terms and conditions at any time. Members will be notified of any significant changes. 7. Liability 7.1. Waiver: Members agree to release and discharge TapoutFitness from any and all claims or causes of action arising out of use of the facility or participation in any program. 8. Governing Law 8.1. Jurisdiction: These terms and conditions shall be governed by and construed in accordance with the laws of the jurisdiction in which the gym operates. Acceptance of Terms By signing up for a membership or using the facilities, members agree to abide by these terms and conditions.
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