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Simply fill in the form below for this great offer 3 PT sessions for just £100 (Can be applied to all services).

Lontech Health Defence

Kick Start Training Questionnaire

Gender
Date of Birth
Day
Month
Year
What is the activity level of your job?
Sedentary (mostly seated)
Moderate (light activity such as walking or standing)
High (heavy labour, very active)
What is your working schedule like?
Are you experiencing any stresses or motivational problems?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as: (tick those which apply)
Please rate your readiness for change, 1 being reluctant, 10 being I'm ready today!
1
2
3
4
5
6
7
8
9
10
What are your reasons for training?
Timeline for achieving your goal.
6 weeks
12 weeks
24 weeks
36 weeks
48 weeks
1 year
2 year
Continuous -life style change/maintenance
Please rate your motivational level to do what it takes for reach your goal. 1 being unmotivated, 10 being excited.
1
2
3
4
5
6
7
8
9
10
Have you trained with a personal trainer before?
At what times during the day would you prefer to train?
How many PT sessions can you commit to each week?

1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Agreed session length will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT


All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

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