Equilibrium - Personal Training for London logo

Complimentary Consultation Request

In order for us to understand how we can best help you progress towards your health and exercise goals, we need to get an idea of exactly where you are current at.
By completing this form we can determine which of our services will be best suited for your needs.

Please complete the form below and one of our trainers will contact you to arrange a meeting time as soon as possible.

Name
Address
Tel no.
Email
Occupation
Age
What services are you interested in?
Why?
In order to devise a safe and effective exercise programme, it is important that you answer all of the following questions honestly and to the best of your knowledge.
Please be advised that all information disclosed is kept strictly confidential.

Do you have a history of, or do you suffer from any medical conditions?

Is there any history of coronary disease or high blood pressure prior to the age of 55 in your family?
If yes, please give details:
Have you been hospitalised or undergone any operations within the last 2 years?
If yes, please give details:
Are you currently taking any form of medication?
If yes, please give details:
Have you ever injured any part of your body?
Does it affect you now?
Is there any other reason not mentioned above (medical or personal) that may prevent you from participating in an exercise programme safely?
If yes, please give details:
What are your Current Exercise Goals?
How close to these goals are you at this point in time?
How committed are you to achieving these goals?
What is your current level of exercise?
What exercise have you done in the past?
Why do you want to work with a trainer?
What days do you prefer to exercise?
Which times would suit you best?
Thank you for taking the time to complete this health questionnaire. One of our trainers will contact you shortly to organise a time for your complimentary consultation.