Health Questionnaire - Pulse Fitness

Step 1 of 4

About you

Let's start with the basics so I know who I'm training.

First Name

Last Name

Email Address

Age

Biological Sex

How would you describe your current fitness level?

Beginner

Little or no regular exercise at the moment

Intermediate

Some regular activity — occasional gym, walks, sport

Active

Exercise regularly, 2–4 times per week

Advanced

Train consistently, high intensity or competitive sport

Step 2 of 4

Health screening

This helps me keep your sessions safe and effective. All information is confidential and used only to plan your training.

Do you have any cardiovascular conditions?

No

Yes

Heart condition, high blood pressure, angina, previous heart attack or stroke

Not sure

Please give a brief description

⚠️ No problem at all — I hold a diploma in exercise referral and regularly work with clients managing cardiovascular conditions. Please bring any relevant medical information to your first session.

Do you have diabetes?

No

Yes — Type 1

Yes — Type 2

Pre-diabetic

Is your diabetes currently managed? (medication, diet, insulin etc.)

Do you have any joint or bone conditions?

No

Yes

Arthritis, osteoporosis, chronic back pain, hypermobility, joint replacements

Which area(s) and how does it affect your movement?

Have you had any surgery or significant injury in the last 2 years?

No

Yes

What was the surgery or injury, and when was it?

Are you currently pregnant or postnatal (within the last 12 months)?

No

Currently pregnant

Postnatal

How many weeks pregnant, or how long ago did you give birth?

Are you taking any medications that may affect exercise?

No

Yes

Beta blockers, blood thinners, insulin, steroids, diuretics etc.

Not sure

Please list the medication(s) (name and what it's for if you know)

Step 3 of 4

Your session

Help me plan sessions you'll actually enjoy and come back for.

What are your main goals? (tick all that apply)

Stay active on holiday

Lose weight / tone up

Build strength

Improve general fitness

Manage a health condition through exercise

Rehabilitation / return to exercise after injury

Just have fun and enjoy it

Where will sessions take place?

Villa garden or terrace

Beach

Hotel grounds

Not sure yet — happy to take your recommendation

Anything you enjoy or want to avoid in a workout? (optional)

Step 4 of 4

Almost done

One final question and your declaration — then you're all set.

Anything else you'd like me to know? (optional)

Declaration

By submitting this form I confirm that the information I have provided is accurate and complete to the best of my knowledge. I understand that it is my responsibility to inform my trainer of any changes to my health or medical condition prior to each session. I acknowledge that personal training involves physical activity and that I participate at my own risk.

I have read and agree to the declaration above

Health &fitness questionnaire.

Health &
fitness questionnaire.