aceRESET Questionnaire - ace lifestyle

About you

First name *

Last name *

Email address *

Phone

Date of birth *

Day

Month

Year

Street Address

City

Postcode

Country

Lifestyle

Occupation *

How Active Is Your Job? *

Do you currently exercise? If no, when did you last exercise? *

If yes, what do you do and how often?

Have you ever tried a home workout programme before? If so what did you do and how did you find it? *

Health history

Age *

Height (in metres) *

Weight (in kg) *

Select

Are you pregnant? *YesNo

Have you had a baby in the last 6 months? *YesNo

If yes, how long ago?

Are you breastfeeding? *YesNoPlease note that this programme may have an effect on the quality of your milk.

Did you have any complications with your pregnancy or after birth, such as a prolapse or separation of stomach wall (Diastasis Recti)Please also include what type of birth you had - natural/C-section

Have you ever had an eating disorder? *

Are you currently taking any medication? If yes, what is it and what are you taking for? *

Are there any physical limitations that would inhibit or limit your participation in an exercise programme? If yes, please tell us why *

Your goals

Why did you join aceRESET? *

What do you want to achieve in the next 10 days? *

What are your goals for the next 3 months? *

What is keeping you from achieving your goals? *

What do you need to do to achieve your goals? *

PLEASE NOTE THAT WE NEED PARTICIPANTS TO PUT IN 100% TO ACHIEVE THE BEST POSSIBLE RESULTSGot it!

On a scale of 1-10 how important is this change for you?10 being the most important!

Terms and conditions

By checking this box, I agree to the terms set forward of ace 12 week transformation Programme and agree to all the terms laid out in the Terms and Conditions for this Programme.

Physical Activity Readiness Questionnaire (PAR-Q)

If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor. Common sense is your best guide when answering these questions please read carefully and answer each one honestly: check YES or NO.

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

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

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

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

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? *YesNo

Is your doctor currently prescribing medication? (for your blood pressure, heart condition etc?) *YesNo

Do you suffer from Asthma? *YesNo

Do you suffer from Epilepsy? *YesNo

Do you know of any other reason why you should not do physical activity? *YesNo

If yes, please comment:

Signed *

In consideration of being able to take part in exercise and physical activity organised by ace lifestyle, I acknowledge that I am physically fit for participating in ace lifestyle activities. I agree to abide by all verbal and written notices regarding safety whilst exercising with ace lifestyle. ace lifestyle shall not be liable for any injury or death I may suffer in these activities.

Full name *

GDPR *Yes, I agree with the privacy policy and terms and conditions.

How did you find out about aceTRANSFORM?

If you are doing the programme with someone else, please provide their name/s to be put in the same group