BASIC INFORMATION
Name *
Name
Date of Birth *
Date of Birth
Phone
Phone
BACKGROUND INFORMATION
Waking Time
Waking Time
Sleeping Time
Sleeping Time
GOALS
Goal 1
Goal 2
Goal 3
TRAINING BACKGROUND
Please be as detailed as possible
Please be specific with the types of exercises performed as well as the duration/recovery, time of day etc.
MEDICAL/DIETARY BACKGROUND
If you answer yes to any of the questions below, please specify
Please be detailed as to when you take them, how much etc.
Have read and understood the Terms and Conditions detailed below? *

PROGRESS PHOTOS

I encourage before and after photos, as these help keep you accountable and are great to actually see the results you begin to make. When clients send me photos (front, side, back), these remain confidential and for my eyes only.


Terms and conditions:

By documenting the above information you are confidentially allowing Balance Fitness and Nutrition access this personal information to tailor an individual plan. Therefore, all information given to you in the future is confidential also. If you are undergoing a training program and/or nutritional plan with Balance Fitness and Nutrition, you must have stated above, any major medical, nutritional issues and/or injuries that may impact on your programs. Balance Fitness and Nutrition is not liable for any past medical, nutritional issue and/or injuries that may impact on program design if not stated above.

By submitting this form you agree to keep all information confidential under Balance Fitness and Nutrition and agree to the terms and conditions of the training program and/or nutrition plan.