Are you currently exercising:
Date of Birth
Your Name:
Your Phone No:
Your email:
Tell me about any health issues or injuries you have. (please select any that may apply:
Awesome thanks. We will be in touch to book you in and get you started. 
Add any further comments or questions below, then click Submit. We will be in touch real soon.
So what are your small immediate goals & your ultimate goal:
Online Health & Fitness Assessment.
 Anyone wishing to participate in a FREE Trialmust complete the following Assessment. 

Below is a questionnaire to complete & submit One of experienced Personal Trainers will review & contact you with advice on which Programs would be best suited to your goals & Fitness level. This information is only used for this purpose & will be held in complete confidence. 
IMPORTANT NOTICE: It is wise to seek your doctor’s advice before beginning any health/fitness/nutrition program!
With doctors and physician support, are you able to participate in an exercise program? 



 
Which Programs & Services you are interested in:
APPOINTMENT TIME: And finally when is the best time/day for you to make an appointment to pop in to start your trial: 


Come along and TRY US OUT!
*for 3  Free Class in one week
Please select one
Not at allA couple times p/wk2-3 times p/wk3+ times p/wkMost days
High Blood Pressure
High Cholesterol
Heart or Lung Conditions
Hernia
Asthma or respitory proplems
Arthritis
Seizure Disorder
Diabetes
Back Pain
Neck Pain
Recent Broken Bones
Joint Issues or limitations
Recent Surgery
Recent Injuries
Muscular Disorders
Other:
YES. Click to agree I am fit to exercise
Any infectious Diseases
Pregnant or given birth recently
Take prescribed medication
Heart or Lung Condition
Group Fitness & Strength Classes
Yoga, Pilates, Meditation & Wellness Programs
RESULTS Club - Women's Weight Loss Program
Personal Training
Women's Only BOOTCAMPS
Kids & Family Classes
Myotherapist, Massage, Nutritionalist or Exercise Physiologist
I'd Like a *FREE Class Pass
I'd Like a 2 Week Trial Membership for $19.95