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Are you an existing client of Personal Training By Karen?*

Please tell me whether you are an existing client or not.

First Name:*
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Last Name*
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Phone No.*
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Your Email*
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Your Age*
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Gender

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Name of Emergency Contact*
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Emergency Contact Phone No.
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It is my professional duty of care to ask all participants to complete the following questions in order to assist with my evaluation and/or to ascertain whether a Doctor's Clearance to Exercise is required.
 
Has a family member, under 60 years, suffered from heart disease, stroke, elevated cholesterol levels, or sudden death?

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Are you currently taking prescribed medication?

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Your medical condition*
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Have you been hospitalised in the last 12 months?

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Are you pregnant?

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Are you postnatal under 6 weeks?

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Do you have an infection at present?

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Do you have a current medical condition that could affect the way you exercise? (E.G asthma, epilepsy, fainting, arthritis)

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Do you have ongoing pain or major injuries?

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Please provide details of your ongoing pain or major injuries
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If you have answered YES to any of the above medical questions you MAY require a signed Medical Clearance to Exercise from your doctor prior to commencing your programme.