Congratulations!

You’ve taken the 1st step toward achieving your health & fitness goals!

In order for our team to have a better understanding of what type of program you are looking for, please complete the following 5-minute Health Questionnaire below.

Please fill in as much information as possible to allow us to have the best possible picture of how we can help you achieve your goals.

We look forward to getting you started soon!

Contact Information
Name:*
First Last
Date of Birth:*
DD slash MM slash YYYY
Email Address:*
Address:*
Street Address Suburb Post Code
Occupation:
Mobile Phone Number:
Home Phone Number:
Work Phone Number:
Emergency Contact Details:
Emergency Contact Name:
Contact Number:
Relationship:
Health Check
Please check the box to the left of the condition if you have any of the following:
- Heart Disease
- Pulmonary Disease
- Metabolic Disease
- Family History of Heart Disease
- High Blood Pressure
- High Cholesterol
- Sedentary Life
- Chest Pain
- Dizziness
- Shortness of Breath
- Irregular/Accelerated Heart Rate
- Osteoporosis
- Arthritis/Joint Pain
- Back Pain/Spine Disorder
- Musculoskeletal Pain/Injury
- Hernia
- Recent Surgery
- Hypoglycemia
- G.I. Disorder
- High Triglycerides
- Cancer
- Pre/Postnatal
- Anemia
- Are you over 50 and not used to being active?
Are you taking any Medications, pills, tablets or supplements that may effect your training?*
- No
- Yes
If Yes, please list or describe your current medication.
Do you have any current injuries or have you suffered any serious injuries in the past?*
- No
- Yes
If Yes, please give a breif description of the injuries.
Current Health & Fitness
Please select type of training you are interested in:*
- 1 on 1 Coaching - (Your own trainer with an individualised program)
- Private Group Training (2-5 people) - (Train with a group of friends and make fitness affordable and fun.)
- Boot Camp - (Come train out our Outdoor & Indoor Boot Camps)
- Corporate Fitness Programs - (Behind every successful business is the hard working loyal employees who work within it. Get your work to invest in a corporate group fitness program at your workplace)
- Emergency Service Fitness Testing - (Program to prepare for the fitness requirements to join any of the Emergency Services - Police, PSO, MFB, CFA or Australian Defence Force)
- Wedding Fitness Program - (Look and feel fantastic on your special day!)
- Fun Run / Charity Event - (Prepare for an upcoming fun run, walk, ride or charity event in Melbourne)
Please select your health & fitness goals:*
- Weight Loss
- Toning + Definition
- Muscle Building
- Improved Fitness
- Healthy Lifestyle
- Sport Specific Conditioning
- Injury Rehabilitation + Recovery
- Other
Please briefly describe the other health & fitness goals you have.
Do you smoke?*
- No
- Yes
Please briefly describe your smoking history. (How long, how often, have you tried to quit)
Exercise History
Have you ever worked with a Personal Trainer / Exercise Physiologist, or been part of a Group Training / Bootcamp program before?*
- No
- Yes - Personal Training / Exercise Physiologist
- Yes - Group Training / Boot Camp
Could you please give a brief overview of your past involvement with these services. (Where, when, likes / dislikes)
What types of exercises and training do you enjoy?*
- Running
- Boxing
- Weights/Strength Training
- Core/Ab Exercises
- Circuit Training
- Mix of everything
- Unsure
How many days a week are you currently working out? (0-7)*
How long are your typical workouts? (ie. 30min weights, 30min cardio, 60min walking, ect)
How many days a week would you realistically like to see yourself working out?*
Describe your ideal Coach / Personal Trainer (personality, type of trainer, special interests / expertise ect.)
Current Nutrition
Are you happy with your current eating habits and nutrition?*
- No
- Yes
If No, what part of your eating habits do you struggle with? Eg. Meal selection, portion sizes, sweet tooth
Do you require assistance with your current eating and diet?*
- No
- Yes
How many sessions a week with a trainer would you like to do?*
- Three sessions a week
- Four sessions a week
- Two sessions a week
- Five + sessions a week
- One session a week
- Not Sure, would like to discuss
We understand that everybody has different goals, time-frames and commitments in their lives. The best results we typically see from our past and current clients, are people that are able to commit to 2-3 sessions per week with a trainer as well as completing 1-2 extra sessions by themselves.
Training Availability & Session Location
What days are you available to train?*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Not Sure
What are your prefered times to train?*
- 5.00am - 6.00am
- 9.00am - 10.00am
- 1.00pm - 2.00pm
- 5.00pm - 6.00pm
- 6.00am - 7.00am
- 10.00am - 11.00am
- 2.00pm - 3.00pm
- 6.00pm - 7.00pm
- 7.00am - 8.00am
- 11.00am - 12.00pm
- 3.00pm - 4.00pm
- 7.00pm - 8.00pm
- 8.00am - 9.00am
- 12.00pm - 1.00pm
- 4.00pm - 5.00pm
- 8.00pm - 9.00pm
Please select the hours that suit your schedule. These don't need to be exact times, but so we can use these as a guide to check our trainers availability.
If your times will vary, or you have particular training time (6.30am - 7.20am for example) please add any additional notes to your prefered times below. We use this section to help arrange a trainer based on your preferred times as best we can.
Terms & Agreements
Agreement & Cancellation Policy
I am aware that if I need to cancel or reschedule my personal training sessions I must contact my trainer 24 hours prior to the session otherwise I will be charged for the session.
I am aware that if I wish to cease my training relationship with Max NRG Personal Training Pty Ltd. trading as 'Moonee Valley Health and Fitness', I am required to give 2 weeks written notice.
Agreement*
- I agree to the Agreement & Cancellation Policy
Terms & Conditions
I wish to participate in the activities and programs of Max NRG Personal Training Pty Ltd ABN 48 045 374 949 trading as 'Moonee Valley Health and Fitness'.

I understand that:a) Portions of the exercise and training program may occur outdoors.b) Exercise carries some risk including, without limitation, risk to the musculoskeletal system and to the cardio respiratory system.

In consideration of Moonee Valley Health and Fitness agreeing to provide training and fitness activities and programs, I release Max NRG Personal Training Pty Ltd, its employees and representatives from any and all responsibilities or liability from injuries or damages resulting from or ancillary to my participation in any activities or my use of the equipment.

I understand and am aware that strength, flexibility and aerobic exercise, including the use of equipment is a potentially hazardous activity. I also understand that fitness activities involve a risk of injury or death, and that I am voluntarily participating in these activities and using equipment with knowledge of the dangers involved. I agree to expressly assume and accept any and all risk of injury or death.

I agree that I have no undisclosed injury or illness that may affect my ability to undertake rigorous exercise and to the best of my knowledge I are ready and able to undertake this exercise program.

I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity exercise and use of exercise and training equipment, so that I might have his/her recommendations concerning these fitness activities and equipment use.

I acknowledge that I have either had a physical examination and been given my physician’s permission to participate, or that I have decided to participate in the activity and use of the equipment without the approval of my physician and assume all responsibility for my participation in activities, and utilisation of equipment in my activities.

Finally, I acknowledge and agree that no warranties or representatives have been made to me by any representative of Moonee Valley Health and Fitness regarding the results I will or may achieve from any program conducted at Moonee Valley Health and Fitness. I understand that results are individual and may vary.
Agreement*
- I agree to the terms

If you have any questions about filling out this form please call (03)9996-0790 or email info@mvfit.com.au

NEW CLIENT – Health and Fitness Form

Congratulations!

You’ve taken the 1st step toward achieving your health & fitness goals!

Contact Information

Emergency Contact Details:

Health Check

Current Health & Fitness

Exercise History

Current Nutrition

Training Availability & Session Location

Terms & Agreements

Agreement & Cancellation Policy

Terms & Conditions

Speak to the MVFit Trainer Team Today