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Let's get to know you - Online

We’re so glad you’re here.
This short form helps us understand your goals, setup, and any health considerations so we can design a safe, personalised online training experience for you.

What This Covers
  • Your online service interest
  • Your home training setup and equipment
  • Your current fitness level and goals
  • Medical and safety screening
  • Consent and policies
It takes approximately 5-10 minutes to complete.
Important: Please read our Terms & Conditions and Waiver & Release of Liability before completing this form.
New Online Client - Halla Wellness
Informed Consent & Pre-Exercise Screening

Personal Information

Your details are confidential and used only to communicate with you and support your training at Halla Wellness
Name
Please enter in format: DD/MM/YYYY
This helps with scheduling and time zones.

How Did You Find Us?

How did you hear about Halla Wellness?
Please provide the name of the person who referred you so we can thank them with a free class!

Which Online Service Are You Interested In?

I'm Interested in... (tick all that apply)

Your Training Setup

This helps me design sessions and programs that actually work in your space, with what you've got.
What equipment do you have at home?
How would you describe your training space?
What device will you use for video sessions?
Only Relevant if you're interested in live virtual sessions.
Do you have a preference for video call platform?

Exercise History

There’s no right or wrong answer here. This just helps us understand your journey so far and how we can best support you moving forward.
Are you currently exercising or playing a sport?
What activities you're doing, how often, and how intense the sessions are.
Which describes you best?

Wellness Self-Rating

Choose a number that best represents how you're feeling right now:
1 = I just want to sleep | 5 = I'm the energizer bunny!
1 = I'm always sick | 5 = What's a doctor?
1 = I get puffed looking at the stairs | 5 = I can run stairs while talking
1 = I need help to carry groceries | 5 = I can lift my own bodyweight

Your Fitness Goals

Select all goals that are important to you

Lifestyle & Exercise Preferences

Select the days that feel manageable in this season of life. This isn’t a commitment — it just helps us shape a schedule that supports our community.
What time of day suits you best?
What types of activities interest you?
Are you following a particular diet?
Totally optional — but the more you share, the better we can tailor things for you.

Health & Medical History

Please answer honestly. This information is confidential and helps us keep you safe while designing a program that supports your body, not work against it.
Do you have any of these conditions?
Select all that apply.

Compulsory Pre-Exercise Screening (PAR-Q)

These questions help identify any potential risks before beginning exercise. If you answer YES to any question, we may recommend medical clearance to ensure your safety.
Heart Condition or history of stroke?
Chest pain during exercie?
Dizziness or fainting during activity?
Asthma attack requiring urgent care in the last 12 months?
Difficulty managing diabetes recently?
Bone/joint problems aggravated by exercise?
Any other condition that makes exercise unsafe?

Photo & Video Consent

Photo/Social Media Permission

Declaration

By submitting this form, you confirm that:
I have read and agree to the Terms & Conditions and Waiver & Release of Liability. I understand the risks associated with exercise.
Type your full name as your electronic signature