Online consultation.

Simply complete this questionnaire for your 6 week workout programme.
The cost for the programme is £20 GBP
Please allow 24 hours as each programme is individually tailored by our health and fitness professionals.

Our Online Consulation form is currently down, it will be back up shortly.

Name		Age
Gender		Height
		Weight
Email Address
Number of children?

When did you last participate in an exercise regime?

Do you suffer or have you suffered from any of the following? (please tick)
	Heart problems
	If so please state Include family history of such

Skeletal problems?	Knees Back Elbows Shoulders

Recent fracture	Osteoporosis Ankylosing Spondylitis Other	If "Other" please describe

Do you suffer from any of the following?	Asthma Diabetes Bronchitis	If there are any other conditions that you think may affect you exercising please state.

Do you smoke?	Yes No	If "No" please state how many per day.

Do you drink alcohol?	Yes No	If so, how much per week? Please describe whether the consumption is spread evenly or all at once. I.e. A weekend.

Do you have access to any of the following to complete your exercise / training programme?	Gymnasium Health club Sports club Running track Cycling track Weights Fit-balls Resistance bands Home only Bicycle Other	If "Other" please describe

Describe your environment	Urban Rural Semi-rural

What would be your specific target for undertaking an exercise regime?	General health Improved muscle tone Weight gain Weight loss Sports specific (please state)	If "Sports specific" please state

If you are already undertaking exercise and training please state which areas you would like to improve.	Cardio vascular fitness Muscular strength Muscular endurance Flexibility

Do you eat a healthy well balanced diet?	Yes No

Would you like a diet / nutritional consultation?	Yes No


Exercise history.

Please write a short description of your exercise history and general fitness condition in order to help design your six week training programme.

How much time do you have available to perform your exercise routine?	Up to 30 mins 30-45 mins 45 mins – 1 hour 1 hour +
	Once a week Twice a week Three times a week Four times a week


Exercise and training programmes differ for each individual and each set of circumstances depending on the needs of the client. Those undertaking sports at competitive levels need to train in order to ensure their body can cope with the stresses placed upon it by the sport. And those who just want to stay in shape for health and recreational purposes need to exercise to control their weight and balance their body to perform in everyday situations. At Investors in Health we believe in providing the right programme for you and once this is achieved the programme will contribute to and benefit individuals in the following ways. Weight management Stress management Blood pressure Improved mobility Improved energy levels Feeling of well being Improved libido

t: +44 1534 873074
e: john.fox@iihltd.co.uk

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