Coach Mankind

Coach Mankind
Client Consultation & Health Screening

Confidential  ·  Completed forms are sent securely to your trainer

Personal Training Mind · Body · Wellness Ayurveda Aligned APSS V2 Certified
A
Client Details
Personal information — all required fields marked *
B
Typical Daily Food & Training Log
Describe a typical day — be as honest as possible
Time of DayFood / MealsTraining / Activity
Morning (AM)
Midday
Snacks
Evening (PM)
C
Adult Pre-Exercise Screening — Stage 1
APSS V2 (2019) · Compulsory for all new clients
⚠️
If you answer YES to any question below, please seek guidance from an appropriate allied health professional or medical practitioner prior to undertaking exercise.
1.Has your medical practitioner ever told you that you have a heart condition, or have you ever suffered a stroke?
2.Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity?
3.Do you ever feel faint, dizzy or lose balance during physical activity or exercise?
4.Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
5.If you have diabetes (type 1 or 2), have you had trouble controlling your blood sugar in the last 3 months?
6.Do you have any other conditions that may require special consideration for you to exercise?
Light IntensityModerate IntensityVigorous / High
Sessions/week
Total min/week
Weighted total = (Light + Moderate min) + (2 × Vigorous min) — Target: ≥ 150 min/week
ℹ️
Under 150 min/week: Light to moderate intensity recommended — increase volume slowly.
150 min+ per week: Continue current intensity. Discuss progression with your trainer.

This screening tool is part of the Adult Pre-Exercise Screening System (APSS V2, 2019). It does not constitute medical advice. Exercise & Sports Science Australia, Fitness Australia, Sports Medicine Australia and Exercise is Medicine accept no liability for any loss or injury.

D
Health & Medical History — Stage 2
Completed with your trainer to determine appropriate exercise prescription
E
Fitness Goals & Consultation
Help us understand what you want — and what's been holding you back
5
1 — Just exploring10 — Fully committed
Goals — What You Want
Pain Points — What's Blocking You
Emotional Impact — The Real Cost
F
Declaration & Consent
Client agreement before submission
✅
I believe that to the best of my knowledge, all information I have supplied within this screening and consultation form is correct. I consent to this information being stored securely by Coach Mankind Personal Training and used to design my personalised training programme.

Your completed form is sent securely to your Coach Mankind trainer.
You will receive a confirmation once your submission is received.

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Form Submitted Successfully

Thank you — your consultation has been received.
Coach Mankind will be in touch shortly to begin your personalised programme.