Pre-Session Health Form — Yield Personal Training

Your details

First name *

Last name *

Email address *

Mobile phone *

Date of birth *

General health questions

Please answer each question honestly. Answer Yes or No

1Has your doctor ever said you have a heart condition or high blood pressure?

Yes No

2Do you feel pain or discomfort in your chest at rest or during physical activity?

Yes No

3Do you lose balance due to dizziness, or have you lost consciousness in the last 12 months?

Yes No

4Do you have a bone, joint, or soft tissue problem that could be made worse by exercise?

Yes No

5Are you currently taking prescribed medication for a chronic medical condition?

Yes No

6Do you have any other condition that might increase your risk during exercise? (e.g. diabetes, epilepsy, respiratory disease, stroke)

Yes No

7Has your doctor ever said you should only do medically supervised physical activity?

Yes No

If you answered Yes to any question above, please provide details

Injuries and physical conditions

Do you currently have pain, injury or limitation in any of these areas? Please answer Yes or No for each

Head / Face

Yes No

Neck / Shoulders

Yes No

Upper Back / Ribs

Yes No

Lower Back

Yes No

Hips / Groin / Pelvic Floor

Yes No

Hamstrings

Yes No

Knees

Yes No

Calf / Shin

Yes No

Feet / Ankles

Yes No

Arms / Elbows

Yes No

Wrists / Hands

Yes No

Details about injuries or limitations?

Fitness background

How would you describe your current activity level? *

Have you done strength training before? *

What are your main goals? *

Is there anything else I should know before we start? (optional)

Pregnancy and lifestyle

PregnancyAre you currently pregnant or have you given birth in the last 12 months?

Yes No

Smoking / vapingDo you currently smoke or vape?

Yes No

Declaration and consent

Please read and confirm before submitting

Full name (as signature) *

Today's date *

Pre-Session Health Screening

Your details

General health questions

Injuries and physical conditions

Fitness background

Pregnancy and lifestyle

Declaration and consent