Name:
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Email Address:
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Telephone number:
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Country of Residence
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Date of Birth:
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Height:
Weight:
How many hours of coaching are you booking?
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What time of day and dates suit you best? Please Include your time zone.
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These dates may not be possible due to my schedule, but it will give us a place to start when it comes to organise sessions.
What are your Health, Fitness and Movement Goals?
Note your short and long-term goals; don't be afraid to write down anything you'd like to achieve no matter how out of reach it seems!
How active are you during an average week?
This includes exercising, walking or cycling to work, and if you work an active job.
What kind of training facilities/equipment do you have available?
What is your injury history?
Please let me know of any current or previous injuries or surgery.
How would you describe your diet?
This could be a particular diet you follow e.g. vegan or keto, or just a general description of your usual weekly diet
If you currently take any minerals / vitamins / supplements please list them below:
Has anything significant happened / or is happening in the past year?
I know this can be quite personal, but this information helps me better understand the situation you are currently in. e.g. going through a breakup, a recent child, a new job or losing a job
How long do you spend outside on an average day?
On average I sleep well and more than 7 hours a night:
Day-to-day I have a lot of energy:
Day-to-day I feel stressed:
I have a sedentary lifestyle:
I am satisfied with my life:
Anything else I should know?
Has your doctor ever said that you have bone or joint problems, such as arthritis that has been aggravated by exercise or might be made worse with exercise?
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Do you have high blood pressure?
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Do you have low blood pressure?
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Do you have Diabetes Mellitus or any other metabolic disease?
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Has your doctor ever said you have raised cholesterol (above 6.2mmol/L )?
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Has your doctor ever said you have a heart condition and should only do physical activity recommended by them?
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Do you have any muscle, joint or back disorders that could be aggravated by physical exercise?
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Do you have any conditions that will prevent you performing exercises including high impact moves, running, jumping, pressing or lifting?
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Have you ever felt pain in your chest when you do physical exercise?
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Is your doctor currently prescribing you drugs or medication?
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Have you ever suffered unusual shortness of breath at rest or with mild exertion?
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Is there any history of coronary heart disease within your family?
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Do you often feel faint, have spells of severe dizziness or have lost consciousness?
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Do you currently drink more than the average amount of alcohol per week (21 units for men and 14 units for women)?
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Do you currently smoke?
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Are you, or is there any possibility you might be pregnant?
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Do you know any other reason you should not participate in a physical activity programme?
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How did you hear of Movementum?
Assumption of Risk
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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, resistance exercise and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me.
Medical/Liability Waiver
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I declare that the information that I have given is true and correct and I hereby recognise the inherent risks with physical training and assume any such risks. I release Billy Morgan from all liability should anything befall me in the course of these coaching services and recognise that the advice and physical training that he provides is not meant as a substitute for the medical advice of physicians.
Session Booking
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If a date cannot be agreed at the end of an in-person session it is up to you, the client, to ensure you book all of your sessions. Movementum will not be held responsible for ensuring all packages and sessions are used and are unable to remind you to book appointments outside of session hours.
Cancellation Policy and Missed Appointments
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We want to make our policy as clear as possible as it can be upsetting when people miss or need to change an appointment, often because of genuine and stressful reasons. It is our policy that clients are responsible for all appointments that they have scheduled. Clients who choose not to attend, or those who call to cancel their appointments at the last minute are still responsible for these appointment times.
Therefore the following policy will apply:
We require a minimum of 24 hours’ notice for cancellation of a session via email, phone call or text message.
For missed appointments, or any appointment changed, altered, moved or cancelled for any reason with less than 24 hours’ notice you will incur the full appointment fee. Short notice cancellations (less than 24 hours) will be counted as one of your sessions.
I understand that emergencies can arise and illnesses do occur at inopportune times. If you have a fever, a known infection, or have experienced vomiting or diarrhoea within 24 hours prior to your appointment time, I request that you cancel your session.
Privacy Policy
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We do not share any of your information with any third parties or profit from your personal information and data. Our Privacy Policy can be found at the bottom of each page.
Declaration of Consent:
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I have completed the Par-Q form to the best of my ability. By signing this I agree that all the information above is correct as of today's date and that if there are any changes to my health I will notify Movementum and if I am ever in doubt about something I hereby agree to communicate clearly in asking for help.
Date Today:
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