Program Design Questionnaire Form

Name*

Email*

please enter the email which you used before purchasing our program.

Phone*

Address*

Date of birth*

Gender*

What is your height in cm?*

What is your current weight in kg?*

What is your goal weight?*

Imagine we had a magic wand, what would your ideal weight be?

Goal*

My physical activity for exercise is currently...*

My physical activity for work/ life is currently...*

How many days per week do you currently workout (or exercise with sports)?*

In terms of my Exercise Knowledge, I am a...*

I currently have access to the following equipment (either at home or the gym)*

What are your most important fitness goals?*

On a scale of 1-10, how committed do you feel you are to making this change?*

Do you have any medical conditions that could affect your program that we should be aware of? (i.e. Diabetes, High Blood Pressure, Injuries, Any other conditions)*

If so, please explain

Has your doctor or GP cleared you for exercise?*

Yes
No

How many meals do you typically eat each day?*

How many meals could you realistically eat each day?*

Try to think about your typical working day. How many meals could you have?

Dietary Requirements/Restrictions*

Please Specify

What do you usually eat for breakfast?*

What do you usually eat for lunch?*

What do you usually eat for dinner?*

What snacks do you usually have?*

How much alcohol do you have each week?*

Be honest. My dad probably drinks more than you, so I won't be shocked 🤣 and I definitely won't judge.

When do you want to start?*

Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*

Yes
No

Do you feel pain in your chest when you do physical activity?*

Yes
No

In the past month, have you had chest pain when you were not doing physical activity?*

Yes
No

Do you lose your balance because of dizziness or do you ever lose consciousness?*

Yes
No

Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*

Yes
No

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*

Yes
No

Do you know of ANY OTHER REASON why you should not do physical activity?*

Yes
No

NKD TRANSFORMATIONS PTY LTD Waiver & Release Form I, understand that I am choosing to voluntarily engage in an exercise program provided by NKD TRANSFORMATIONS PTY LTD, which may include but not limited to, weight and/or resistance training, cardiovascular training, and/or stretching. I hereby agree to the following: 1. I understand that the results of any fitness program cannot be guaranteed, and that my progress depends on my effort and cooperation in and outside of the sessions. 2. I understand that I have the right to ask questions and receive explanations of exercises, equipment, or any fitness-related matter. 3. I understand that the trainers or employees of NKD TRANSFORMATIONS PTY LTD are not licensed medical care providers and cannot provide medical diagnosis, treatment, or advice. 4. I warrant and represent that I am in good health, and I have no physical or mental condition that would prevent me from participation in the exercise program provided by NKD TRANSFORMATIONS PTY LTD. 5. I acknowledge that participation in the exercise program involves risks, including but not limited to, risk of injury, aggravation of pre-existing conditions, or death. 6. I voluntarily assume all risks associated with participation in the exercise program, and I agree to release and hold harmless NKD TRANSFORMATIONS PTY LTD and its officers, agents, employees, successors, and assigns from any and all claims, liabilities, damages, or causes of action arising out of my participation in the exercise program. 7. I understand that NKD TRANSFORMATIONS PTY LTD may use photos or videos taken during my training sessions for promotional purposes, and I grant NKD TRANSFORMATIONS PTY LTD permission to use my likeness for such purposes. I have read this waiver and release form in its entirety, and I fully understand its contents.*

I agree to this waiver and release form voluntarily and of my own free will.

If you answered 'YES' to one or more questions,

Talk to your doctor by phone or in-person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.

You may be able to do any activity you want – as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.

Find out which community programs are safe and helpful for you.

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can: Start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go. Take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active: If you are not feeling well because of a temporary illness such as a cold or a fever – wait until you feel better If you are or may be pregnant – talk to your doctor before you start becoming more active.

Please note:

If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.

Program Design Questionnaire

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