New Client Questionnaire
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New Client Questionnaire

Please complete this form before your first session.

This screening tool does not provide advice, or substitute for advice from medical professionals. This screening tool does not guarantee against injury or illness, and no liability will be taken by Jay Bartle for any loss, damage or injury that should arise from any person acting on any statement or information contained in this tool.

01 // Your Details
02 // Conditions Requiring Medical Clearance

1.Have you ever had a heart condition, heart attack or stroke?

2.Do you ever experience chest pains at rest or during physical activity?

3.Do you ever feel faint or experience dizziness during physical activity?

4.Have you had an asthma attack requiring medical attention in the last 12 months?

5.Do you have diabetes, type I or II?

6.Do you have any muscle, bone or joint problems that could be made worse by participating in physical activity?

7.Do you have any parents or siblings who suffered a heart attack before 55 (male) or 65 (female) years old?

8.Do you smoke regularly or have you quit in the last 6 months?

9.Are you physically active for at least 150 minutes (2.5 hours) per week?

10.Do you have high cholesterol?

11.Do you have high blood sugar?

12.Have you had any joint surgery in the last 6 months?

13.Do you have blood pressure above 140/90?

14.Do you have epilepsy?

15.Do you have any other medical conditions to declare?

03 // Getting To Know You
04 // Agreement & Declaration

Warning: This is a legal document that affects your rights

Agreement for participation in personal/group strength, fitness and conditioning training. The 'Trainer' refers to Jay Bartle. The 'Activity' refers to the participation in personal/group strength, fitness and conditioning training and general advice.

I acknowledge that it is a condition of participating in this activity that I do so at my own risk. I accept all risks and hereby indemnify and release the trainer, their agents, affiliates, employees, members, sponsors, promoters and any person or body directly and indirectly associated with the Trainer, against all liability (including liability for their negligence and the negligence of others) claims, demands, and proceeding arising out of or connected with my participation in this activity.

This release and indemnity continues forever and binds my heirs, successors, executors, personal representatives and assigns.

I acknowledge that participation in this activity may involve a risk of serious injury or even death from various causes including: over exertion, dehydration, equipment failure and accidents with equipment and surroundings.

I recognize the difficulties associated with the activity and attest I am physically fit to participate safely in the activity and that a qualified medical practitioner has not advised me otherwise.

I understand the demanding physical nature of this activity. I am not aware of any medical condition, injury or impairment that will be detrimental to my health if I participate in this activity. In the event that I become aware of any medical condition, injury or impairment that may be detrimental to my health if I participate in this activity my Trainer will be immediately informed. By continuing to participate in this activity, I accept the risks despite these conditions and am still, and will always be under the terms of this agreement.

Parent/guardian to sign if under 18 years of age.