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    Name (required)


    Phone Number

    Email Address

    Emergency Contact Name and Number



    Date of Birth

    What is your occupation?

    How active is your work? (Standing, sitting, lifting ect?


    Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly.

    1. Have you ever suffered from an eating disorder (for example Anorexia nervosa or Bulimia nervosa)? YesNo
    2. Enter more info here if yes

    3. Do you have Diabetes Mellitus or any other form of Diabetes? YesNo
    4. Enter more info here if yes

    5. Are you currently receiving guidance from another professional relating to weight loss, fat loss, muscle gain or body recomposition ("toning")? YesNo
    6. Enter more info here if yes

    7. Has anyone in your immediate family had a heart attack prior to the age of 55 years? YesNo
    8. Enter more info here if yes

    9. Has your Doctor ever said you have raised cholesterol levels? YesNo
    10. Enter more info here if yes

    11. Do you suffer from Epilepsy? YesNo
    12. Enter more info here if yes

    13. Are you or do you think you may be, pregnant? YesNo
    14. Enter more info here if yes

      Is there any other reason, medical or otherwise that may affect your suitability for nutrition advice? If yes, please comment below

      Enter more info here if yes


    I understand that if my health changes so that I then answer YES to any of the above questions, I will inform my trainer and ask whether I should change my plan.

    I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities, which may include aerobic exercise such as running, jumping and rowing, resistance exercise (including but not limited to barbells, dumbbells, kettlebells and various weight-training equipment) and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death.

    I understand the results of any fitness program cannot be guaranteed and my progress depends on my effort, cooperation and adherence.

    I understand that Reach Fitness Group UK Ltd may photograph and/or film their client events/sessions and I agree to allow them to use these pictures, films, and/or likenesses of me for promotional purposes. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform Fitness Group UK Ltd of this in writing.

    I will not to allow any other health or fitness professional to use my progress pictures as a representation of their coaching with me. I acknowledge that any progress made whilst following the programme, principles and support of Reach Fitness Group UK Ltd and/or coaches working for Reach Fitness Group UK Ltd will be acknowledged as such and I will not allow other parties to take credit for my progress.

    I agree that Fitness Group UK Ltd shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, at the training studio, outdoors, or at a corporate, commercial, residential or other fitness facility) and I expressly release and discharge Reach Fitness and its owners, employees, agents and/or assigns, from all claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program, excepting only an injury caused by the gross negligence or intentional act of such person or persons. This Release shall be binding upon my heirs, executors, administrators and assigns.

    I Agree that I have read and agree to the statements above