Pre-Training Screening

Personal Information

Let's start with the basics

Full Name *

Date of Birth *

Gender *

Phone Number *

Email Address *

Current Weight (kg) *

Current Height (cm) *

Emergency Contact Number *

Relation to You *

Your Goals

What are you working towards?

What are your 3 main goals? *

Be specific - this helps me design the perfect program for you

Why are these goals important to you? *

Understanding your 'why' helps keep you on track when things get tough

Days per week you can commit *

Goal timeline *

Physical Activity

Tell me about your current activity level

Do you currently exercise? *

Yes, I currently exercise

No, I don't currently exercise

How long have you been exercising?

How often do you exercise?

Do you do or have done any physical activities or sports? *

This helps me understand your experience and build on what you know

Training History

Have you worked with a trainer before?

Have you worked with a personal trainer before? *

Yes

No

Why did you stop training with them?

Why have you chosen to work with Jayden? *

Something you enjoy (doesn't have to be fitness related) *

Training works best when it fits into your life, not the other way around

Health Screening

This information ensures we train safely and effectively

Have you or a blood relative (under 55) suffered from heart disease, stroke, elevated cholesterol, or sudden death? *

Yes

No

Please specify:

Do you have high blood pressure? *

Yes

No

Are you a smoker or have smoked in the past? *

Yes

No

Do you suffer from high cholesterol? *

Yes

No

Do you have or have suffered from diabetes (Type 1 or 2)? *

Yes

No

Are you on prescribed medicine that might affect your training program? *

Yes

No

Please specify medication and how it might affect training:

Are you pregnant or have given birth in the last 12 months? *

Yes

No

N/A

Have you had any major injuries involving your neck, back, hips, knees, shoulders, or ankles? *

This helps me modify exercises to work around any limitations

Do you have or have suffered from epilepsy, arthritis, hernia, asthma, dizziness/fainting? *

Any other health concerns we should know about? *

Personal Information

Your Goals

Physical Activity

Training History

Health Screening

Screening Complete!