Information

Name

Email

Phone

Sex select female male

Age

Height

Weight

Your training goal

Tell us something more about yourself

If you would like to give us more information so that we could learn more about your needs, please fill in the form about your health.

Have you ever had any injuries?
(Yes/No. If so, describe them)

YES

NO

Have you got high blood pressure?
(Yes/No. If so, write how high)

YES

NO

Have you ever suffered from joint pain?
(If so, which one) cervical vertebra thoracic vertebra lumbar vertebra sacra vertebra shoulders elbows wrists hips knees ankles

Have you recently been hospitalized?
Have you ever had any surgery?

YES

NO

Are you currently taking any medication?

YES

NO

Eating habits interview

How many times a day do you eat? select 2-3 3-4 4-5 more than 5

What is the period between your wake up and your first meal? select no more than 1h between 1 and 2h more than 2h

What is the period between your dinner and going to bed? select no more than 30 minutes 30-60min between 1 nad 2h more than 2 h

How much water do you drink a day? select 0,5-1 1-2 more than 2

Do you drink anything else?
(If so, what kind of drinks)

Training capabilities

Determine the level of your physical activity select low (I sit most of the day) medium (I stand for most of the day) high (I do sport)

Where would you like to train? select fitness club home office outdoors

How often do you train? select never from time to time several times a weeks fitness is a part of my life

How many training sessions a week would you like to attend? select 1 2 3 4 moer than 4)

What areas do you want to concentrate on? tighs buttocks chest stomach calfs arms shoulders back hips

Is there anything else you would like to tell us about?