Medical History
Online Personal Training
What you get...
- Effective exercise program - Variety
- Motivation - Knowledge
- Encouragement - Accountability
and more...
- Access to your workouts ANYTIME and ANYWHERE
- Ability to train at home, in hotel rooms, outside, etc.
- Website resources: exercises, recipes, fit tips, trainer's blog, articles
- Daily interaction with your trainer
- Daily food and workout logs
- Daily food and workout logs
- Weekly accountability phone call
Do it now. You become successful the moment you start moving toward a worthwhile goal. ~Unknown
A Fit Place
Personal Trainingext.
Personal Trainingext.
Training Packages
Nutrition Only - Daily feedback from nutrition logs
- No workout info provided Email Coaching - 2 personalized workouts per month
- Unlimited email contact with a trainer
- 2 personalized workouts per month - Unlimited email contact with a trainer - Daily feedback from nutrition logs - Daily feedback from workout logsPersonal Coaching - 3-4 personalized workout per month
- 3-4 personalized workout per month - Unlimited email contact with a trainer - Daily feedback from nutrition logs - Daily feedback from workout logs - 1 accountability phone call per weekTraining Forms
Contract/Agreement
Congratulations on your decision to participate in an exercise program! With the help of Jenny LaBaw, your personal trainer, you greatly improve your ability to accomplish your training goals faster, safer and with maximum benefits. The details of these training sessions can be used for a lifetime.
In order to maximize progress, it will be necessary for you to follow program guidelines. Remember, exercise and healthy eating are EQUALLY important.
During your exercise program, every effort will be made to assure your safety. However, as with any exercise program, there are risks, including increased heart stress and the chance of musculoskeletal injuries. In volunteering for this program, you agree to assume responsibility for these risks and waive any possibility for personal damage. You also agree that, to your knowledge, you have no limiting physical conditions or disability that would preclude an exercise program.
A physician’s examination is recommended for all participants with any exercise restrictions and all men >44 years old and all women >54 years old. Personal training participants in either or both of these categories who do NOT have a prior physician examination MUST acknowledge they have been informed of its importance. By signing below, you accept full responsibility for your own health and well-being. You acknowledge an understanding that no responsibility is assumed by the leader of the program, Jenny LaBaw.
Personal training Terms and Conditions
1. Payment due days are on the 7th and 21st of each month. Your trainer WILL NOT post new exercise programs until payment for the month has been received. No exceptions!
exercise programs until payment for the month has been received. No exceptions! 2. No personal training refunds will be issued for any reason, including but not limited to travel, illness, and missed workouts.
3. The expiration policy states that training will end at the conclusion of the allotted time frame - beginning on the first posted program.
4. Logging of workout and nutrition data is held in the responsibility of the client. Without logs, feedback from your trainer is impossible.
I wish you the best on your new personal training program!
Fax:
Phone:
Physician:
Gender:
Weight:
DOB:
Age:
Height:
Date:
Occupation:
Name:
Other
Rheumatic fever
Diabetes
Fainting or Dizziness
Heart Attack
Lung Disease
Seizures
Low Blood Pressure
Injury to back or knees
High Blood Pressure
Edema (Swelling of Ankles)
Recent Operatipn
Temporary loss of visual acuity or speech, or short-term numbness or weakness in one side or your body
Unusual fatigue or shortness of breath with usual activities
Known Heart Murmur
Intermittent Claudication (calf cramping)
Pain, discomfort in the chest, neck, jaw, arms or other areas
Palpitations of tachycardia (unusually strong or rapid heart beat)
Chest Pains
Nocturnal Dyspnea (shortness of breath at night)
Orthopnea (need to sit to breath comfortably)
High Cholesterol
Please explain "Y" answers below:
Past/Present History
Have you had OR do you presently have any of the following conditions? (Check if yes.)
Have you had OR do you presently have any of the following conditions? (Check if yes.)
Family History
Have any of your first-degree relatives (parent, sibling, child) experienced the following conditions? (check yes.) In addition, please identify at what age the condition occurred.
Have any of your first-degree relatives (parent, sibling, child) experienced the following conditions? (check yes.) In addition, please identify at what age the condition occurred.
Other major Illness
Diabetes
High Cholesterol
High Blood Pressure
Congenital Heart Disease
Heart Operation
Heart Attack
If so, please explain:
Personal History
List any medications you are currently taking.
Do you have injuries? (bone or muscle disabilities) that may interfere with exercising?
Can you currently walk 4 miles briskly without fatigue?
How much per day and for how long?
Do you smoke?
Please explain "Y" answers below:
1. What are your goals? Short term? Long term?
2. What is your current weight training routine?
3. What equipment do you have access to? (weight machines, benches, step, balls, BOSU, bands, free weights, medicine balls, cardio equipment, etc.)
7. What is your phone number, mailing address, username and password you want to use to log in to the site? I need your phone number so I can call you to explain everything initially and the other info to get you set up on the site. I am the only one that will have access to this.
6. Any injuries or restrictions you have that may be of concern?
5. What specific days (Monday-Sunday) and time (hours:minutes) can you committ to for training each week?
4. What do you do for cardiovascular fitness? (walk/run/hike/bike/treadmill/elliptical/spin/row...)
Pre-Training Questionnaire
Participants Name:
Date:
Cancellation Policy
Upon signing below, I certify my understanding of the following cancellation policy held by A Fit Place:
In agreeing to participate in online personal training with A Fit Place and afitplace.com, I understand and agree that if I terminate my training contract before the term is complete, I will pay a cancellation fee of $150. The term of a training contract begins on the first day a program is posted to me and ends on the same day of the month in the agreed month(s) contract. For example: 6 month program starts on April 1st, 2009 and ends on October 1st, 2009.
Particpant's Signature:
Date:
Rates
| ||||||
| ||||||
| ||||||
| ||||||
