G&T Stafford - Personal Fitness Success Survey Questions

First Name
Last Name
Email
Phone
Date of birth:
Current Job:
How did you hear about us?:
What facilities are you most interested in?:
Are you interested in any of the following extras we offer?:
Please select the following options:
The main reason/s that have held me back from joining a gym before are:
I would rate my health and fitness presently at (1 = lowest, 10 = highest):
My health and fitness goals are to:
How eager are you to get started? (1 = lowest, 10 = highest):
How many times per week are you looking to come to the gym?:
Fitness Survey Staff Notes:

HEALTH QUESTIONNAIRE

Has your doctor ever indicated that you have a heart condition?:
Has it been suggested that you should only undertake physical exercise that has been recommended by a doctor?:
Do you feel pain in your chest when you undertake physical exercise?:
In the past few months have you had chest pains when you were not participating in physical exercise?:
Do you ever lose your balance because of dizziness?:
Do you ever suffer from loss of consciousness or fainting?:
Do you have a bone or joint problem?:
Is your doctor currently prescribing medication for you?:
Do you know of any other reason why you should not partake in physical activity?:
Please tick this box to confirm your answers are correct: