Full Name:
Age:
 
Date of Birth:
Email:

Full Name:
Relationship:
Telephone Number:

Have you ever trained at a gym or under a personal trainer?

 

Where do we come into the plan for you, how can we assist you in reaching your goals?:

 

 

 

**We recommended that you seek a medical clearance from your health professional prior to commencing any exercise program.**

Signing Section

I confirm that I have read through in full this electronic form including the attachments, the Membership Form, and the Membership Terms and Conditions.
I confirm that the details and information that I have provided within this Health Questionnaire Form is true and correct.
I confirm that I have read and understand the Terms & Conditions.
I consent to the electronic signature of this Health Questionnaire Form.

 

Leave this empty:

Signature arrow sign here

Signed by Liam Carrick-Ryan
Signed On: January 12, 2022


Signature Certificate
Document name: Health Questionnaire Waiver
lock iconUnique Document ID: c73557691793478de325f41dfa77c855aed10b35
Timestamp Audit
October 24, 2021 6:38 pm AEDTHealth Questionnaire Waiver Uploaded by Liam Carrick-Ryan - info@transformfitness.com.au IP 99.24.222.23