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Please enter your details below.

I will then contact you to confirm all your details and discus options for your fitness programme.

And if you sign-up now, you will receive your first week's training programme absolutely free. That way, you can trial On Track at no risk to you!

On Line Registration

First Name:

Last Name:

Address 1:

Address 2:

City:

Country:

Date of Birth:

e.g. 25 September 1967

Gender:

Female
Male

Phone:

I was referred by:

if referred by a friend

1.	What are your long-term health and fitness goals?
2.	How do you expect the personal trainer to help you meet your fitness goals?
3.	What type of information would you like the trainer to cover in the sessions? (check all that apply) Muscle building Weight loss Cardio fitness Other:
4.	Do you have any pre-existing injuries or physical restrictions that may limit your ability to execute certain exercises? If so, please list:
5.	Do you currently take any nutritional supplements or follow any special diet, e.g. vegetarian, low calorie? If so, please list:
6.	Mark the meals you consume in an average day (including snacks): Breakfast Morning Tea/Snack Lunch Afternoon Tea/Snack Dinner Dessert/Snack
7.	Are you currently taking any medications or drugs? If so, please list the medication or drug, dose, and reason:
8.	How many hours of sleep do you normally obtain in a day?
9.	Indicate your energy level by selecting the corresponding number below: (very low) 1 2 3 4 5 6 7 8 9 10 (very high)
10.	Indicate how you are dealing with daily stress by selecting the corresponding number below: (not well) 1 2 3 4 5 6 7 8 9 10 (very well)
11	Have you ever begun an exercise program and then stopped? If so, when? Why did you stop?
12.	Typically what time of day would you train?
13.	What facilities and equipment do you have access to? Please specify:
14.	How regularly can you exercise per week?
15.	Please include below any other information that may be relevant to your health and fitness: