The UQ HMNS Personal Trainer Service will be offered in Semester 1 and Semester 2 in 2019. Please complete all relevant information below and select the package of your choice. You will be contacted shortly after completion of this survey to notify you of your eligibility and upcoming important dates. Thank you for your time!

Question Title

* 1. Full name.

Question Title

* 2. Gender.

Question Title

* 3. Date of Birth.

Date / Time

Question Title

* 4. Best Contact Number.

Question Title

* 5. Email Address.

Question Title

* 6. Current Physical Activity (e.g. Walking 3 days/wk for 30min).

Question Title

* 7. Preferred session time. Please order your top 3 preferences.

Question Title

* 8. Time preference on your 1st choice.

Question Title

* 9. Additional comments regarding your time preferences.

Question Title

* 10. Please select your preferred package option.

Question Title

* 11. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?

Question Title

* 12. Do you ever experience unexplained pains in your chest at rest or
during physical activity/exercise?

Question Title

* 13. Do you ever feel faint or have spells of dizziness during physical
activity/exercise that causes you to lose balance?

Question Title

* 14. Have you had an asthma attack requiring immediate medical
attention at any time over the last 12 months?

Question Title

* 15. If you have diabetes (type I or type II) have you had trouble
controlling your blood glucose in the last 3 months?

Question Title

* 16. Do you have any diagnosed muscle, bone or joint problems that you
have been told could be made worse by participating in physical
activity/exercise?

Question Title

* 17. Do you have any other medical condition(s) that may make it
dangerous for you to participate in physical activity/exercise?

Question Title

* 18. Do you have any immediate family members (i.e. parents/siblings) that have suffered a heart attack or stroke? If no, please type no. If yes, please detail your relation to the person and the age they were diagnosed (e.g. father, age 60).

Question Title

* 19. Have you ever been told you have high blood pressure?

Question Title

* 20. Have you ever been told that you have high cholesterol?

Question Title

* 21. Have you ever been told you have high blood sugar?

Question Title

* 22. Have you recently been injured, require rehabilitation exercises or seeking a sport specific program to aid in current sport specific training? If no, please type no. If yes, please provide details. 

Question Title

* 23. Have you spent time in hospital (including day admissions) for any medical condition/illness/injury during the last 12 months? If no, please type no. If yes, please provide details.

Question Title

* 24. Are you currently taking a prescribed medication(s) for any medical condition(s)? If no, please type no. If yes, please provide details. 

Question Title

* 25. Are you pregnant or have given birth within the last 12 months? If no, please type no. If yes, please provide details.

T