Pre Training Questionnaire

Contact Details

Please fill in your contact details.

Firstname:*
Surname:*
Phone - Mobile:*
Email:*
Date of Birth:* Day Month Year
Gender:*
Street Home:*
City/Suburb:*
State:*
Postcode:*
Q 1: Which area are you based nearest to?
Q 2: Breifly describe your current exercise regime:
Q 3: Do you know anyone who trains with Evolution Outdoors already?
[1]
[2]
[3]
[4]
Q 4: If referred, who referred you?
Q 5: Who are you bringing with you? (option to provide us with their name and number or email address and we will invite them along)

The information obtained will be treated as confidential and will not be released or revealed to any person unless authorised.Although every effort is made to ensure the best health and safety practices are met in all activities, Evolution to Wellbeing do not accept any responsibility resulting in loss or injury to persons in the program.

Q 6: Have you ever suffered from or currently have any of the following?
High Blood Pressure >140/90
High Cholesterol/triglycerides
Arthritis
Any heart/stroke condition
Asthma
Diabetes
Stomach/Duodenal Ulcer
Liver/Kidney Condition
Exercise induced asthma
Allergy induced asthma
Q 7: Are you on any medication? If so what.
Q 8: Do you have any allergies?
Q 9: Is there anything else you want to tell us that might affect your ability to train?
Q 10: I understand that I am responsible for my own participation in any activities undergone in Evolution to Wellbeing classes or associated classes. I have answered all questions regarding any medical history and recent medical treatments received by me and will continue to inform Evolution to Wellbeing any information which will affect my health and wellbeing in regard to my participation in any program.
I have read and agree to the statement above
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Evo 10 Day Cleanse Dates

2nd Feb, 2009

18th May, 2009

7th Sept, 2009
 

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