Strive Client Report Form — Balance Fitness & Nutrition

HOME ABOUT COURSES SHOP BLOG Contact

EVENTS, WRITING, PEOPLE, BRANDS PREGNANCY EGUIDES STRIVE PROGRAM

HOME ABOUT COURSES SERVICES EVENTS, WRITING, PEOPLE, BRANDS PREGNANCY EGUIDES STRIVE PROGRAM SHOP BLOG Contact

Balance Fitness Nutrition_Image_15.jpg — STRIVE client report form

Please complete and submit the form below ASAP.
At your first Strive session a will also require you to sign a Waiver & Release of Liability form.
Any questions please contact me!

BASIC INFORMATION

Name *

First Name

Last Name

DOB *

Contact Phone Number *

Email *

Postal Address *

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

BACKGROUND INFORMATION

Height *

Weight *

Main areas store fat *

Usual waking time & sleep time *

Work and/or Study *

List your hours

Do you either: *

Struggle to lose weight

Struggle to hold lean muscle/weight

Build muscle easily & stay quite lean

List the top reasons / short term goals as to why you are signing up for the STRIVE Program *

On a scale of 1-10 can you rate your degree of focus and intention to achieve your current goals? *

1 being the lowest and 10 being the highest

Outline what your current training routine looks like. Include resistance training, cardiovascular exercise, sports etc *

Please be specific with the types of exercises performed as well as the duration/recovery, time of day etc

Have you had a trainer before? If so; when, how long did you train with them, what did you like/dislike, results? *

Please detail any fitness activities you like & dislike *

MEDICAL BACKGROUND

Have you had any major surgeries or illnesses that may impact training or nutrition plan? *

List any surgery in past 12 months

Do you take any supplementation or medication? If so, how much, what brands, when and for how long been taking? *

Please be detailed as to when you take them, how much etc

Do you have any present or previous injuries? If so, please explain where, how, recovery etc *

Have you ever been told that you have a heart condition? *

If you answered YES to the question above please list any details here

Have you ever had a stroke? *

If you answered YES to the question above please list any details here

Do you ever have unexplained pains in your chest at rest or during physical exercise? *

If you answered YES to the question above please list any details here

Do you consistently feel faint or suffer from spells of dizziness? *

If you answered YES to the question above please list any details here

Do you suffer from asthma and require medication? *

If you answered YES to the question above please list any details here

Do you suffer from type I or II diabetes? *

If you answered YES to the question above please list any details here

Do you suffer from any major muscle or joint conditions that may limit you or be aggravated by physical activity? *

If you answered YES to the question above please list any details here

Do you suffer from any medical conditions that may be made worse by participating in physical activity? *

If you answered YES to the question above please list any details here

Do you suffer from high blood pressure over 140/90 or low blood pressure below 100/80? *

If you answered YES to the question above please list any details here

PRE OR POST NATAL

Do you have children? *

If YES, please answer the following questions below

Date of delivery

Type of Delivery (C section, vaginal)

Breastfeeding status:

6 week check-up date & outcome (Physio & Doctor):

ADDITIONAL QUESTIONS

Do you have or have you suffered any of the following? If YES please tick *

Symphysis Pubis Dysfunction (pain in the central pubic area)

Carpal Tunnel Syndrome (wrist/finger/hand forearm pain/numbness or tingling)

Upper back/neck/shoulder pain

Incontinence (urinal or faecal)

Piles, hemorrhoids, varicose veins, constipation

Gestational Diabetes

Join pain/muscle pain

Sacrum or Sacoiliac Joint pain (pain in the very low mid back - top of buttocks)

Knee pain (side, front, back)

Coccyx damage or pain

Prolapse (uterine, bladder, rectum, vaginal)

Episiotomy cut, painful perineum or tears (degree if known)

C-Section wound discomfort or slow healing or ongoing numbness

Buttock/piriformis pain/sciatica

Bleeding during or after exercise or any unexplained bleeding

History or current episodes of high/low blood pressure, episodes of faintness, dizziness or breathlessness

Separation of your abdominal muscles

Breast health, breast feeding issues, mastitis

Nerve damage during birthing (pudendal)

Anaemia or taking iron medication

Other please specify

If you selected 'Other' please provide details here

TERMS AND CONDITIONS

I agree to the following *

By documenting the above information you are confidentially allowing Brooke Turner of 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 Brooke Turner of Balance Fitness and Nutrition, you must have stated above, any major medical, nutritional issues and/or injuries that may impact on your programs. Brooke Turner of 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. 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.

Thank you!

Follow @BalanceFitnessAndNutrition

• 8 YEARS TODAY •

Eight years married to my number one ❤️

What a day it was and what a journey it has been - I think we make a pretty great team!

My biggest supporter & the best Dad to our munchkins. I love doing & couldn’t imagine life without you @philjt

P.s I’ve linked our wedding video in my bio if you want to see more from our special day x

📷 @krysta.guille.photography
•
•
•
•
•
#weddinganniversary #marriage #husbandandwife #weddingday #love #whatateam #australiassouthwest @maitrayaretreat

• WHAT TO EAT WITH A BABY ON BOARD? •

You definitely do not need to ‘eat for two’, as the old saying commonly suggests.

It is more important as to WHAT you actually eat to ensure that you and your growing babe are getting the nutrients needed.

Check out my blog on Nutrition for Pregnancy (link in my bio) to learn more about changes to your energy requirements, foods & nutrients you should be eating more of and why and what to avoid.

As far as cravings go it’s often said it can be a sign of a deficiency but may also just be a great excuse to eat what you want 😉

What kind of whacky, wonderful, delicious or disgusting things did you crave during pregnancy?
Or did you have none?

•APPROPRIATE ALTERNATIVES, ALWAYS •

When it comes to training Mums!

If you are taking one on one PT’s & small group training then you should know the details of your Mum clients birth and recovery to appropriately program each and every session.

BUT when it comes to larger group fitness classes, particularly if you work at a gym where YOU haven’t seen every member / clients pre exercise questionnaire or know every one personally (think LesMills, F45, CrossFit - any large group training). Then there is a high chance you’re not going to know the nitty gritty of every single member.

Even if you ask at the start of a session, someone who has never met you before or are yet to build a rapport with may not feel comfortable saying ‘oh yeah I leak a bit when a jump’.

Nor may they know a more suitable option to take (or be brave enough to do something different to others), should they not feel comfortable doing the programmed movement.

This

• WAS IT A FACTOR? •

I’d always wanted three kids, but after carrying two pregnancies, having two vaginal deliveries, a mild prolapse and a love for movement I was worried about how a third pregnancy & birth may impact my pelvic floor.

It definitely played on my mind when we were planning baby number three and something that has been there throughout my pregnancy.

The thing with pelvic floor dysfunction is that it’s not just labour and delivery that can impact it, so a cesarean isn’t necessarily going to eliminate that risk. Pregnancy is what causes the stretching & weakening of the PF and can contribute to prolapse and incontinence.

It does however take the risk out of what could happen during the birth process, which is always unknown.

Thanks to the over-thinker in me I’ve seen my Women’s Health Physio, the OB and now a specialist to discuss my concerns which has helped greatly with the ‘How will I fair after all of this?&rsq

• BECOME A LEADING PRE & POST NATAL FITNESS SPECIALIST! •

There are now just 3 weeks to go until the very first Functional Fitness for Pregnancy and Post Partum LIVE Virtual Training Course!

This course is now 90% full with just a couple of spots remaining!

We will have amazing fitness professionals from all over Australia joining this intake and I can’t wait!

This is the complete pre and post natal training package for fitness professionals working with women throughout their pregnancies, return to exercise and motherhood journeys.

My mission is to educate and empower women and fitness professionals working with women to understand the importance of safe and effective exercise and nutrition throughout pregnancy and the post natal period.

If you’re ready to become a specialist in functional fitness for pregnancy and post partum, comment with ‘I’m ready!’ in the comments below or send me through a DM so that I can let you know more about

• GOTTA KEEP MOVING •

Many ask how I have the energy to exercise or what my week of movement looks like.

I aim to do some form of structured exercise most days, but it is by no means excessive.

It’s enough for me to feel happier, relieve some stress and know that I took some time for ‘me’.

The biggest motivator for me to move is for my mental health.
➡️Then there are other reasons like maintaining my health and fitness to avoid pregnancy related problems.
➡️Then there’s the fact that’s it’s simply a habit that I have formed over my life and something that I LOVE to do!

Here’s how this week looked:
Monday: 15 mins - lounge room body weight workout from my eBook in my PJ’s 💤
Tuesday: 30 mins - LesMills SPRINT Class 🚲
Wednesday: 25min incline walk on the tready 🚶&zwj;♀️
Thursday: 45mins - 1km laps + some water walking 🏊&zwj;♀️
Friday: 30mins - 200cal on the air bike. 🚲
Saturday: nothing structured but a little rock

Balance Fitness and Nutrition

Karratha WA 6714,

Australia

HOME | ABOUT | PREGNANCY EGUIDES | STRIVE PROGRAM | EVENTS & COLLABS | SHOP | BLOG | CONTACT

© BALANCE FITNESS AND NUTRITION 2021. ALL RIGHTS RESERVED.

WEBSITE DESIGN BY PURE DESIGN CO

PROUDLY SUPPORTED BY THE
CITY OF KARRATHA GRANTS SCHEME

City of Karratha Logo_White.png