Registration Form

Vajrah Well-being

(This information will be kept strictly confidential and only be used for the purposes of designing your training program)

Name
Email
Phone Number
Sex
Date Of Birth

BODY COMPOSITION TEST (optional)

Weight(in Kg)
Height(in Cm)
Eating Habit
Occupation
Describe your Job
Do you consume alcohol or tobacco products?
Do you have any injuries or health problems? If yes please describe
Are you under medication? If yes please provide the details
Did you consult your physician before the training session?
On a scale of 1-10, how would you rate your health level (1=very low; 10=very high)
How many hours do you regularly sleep at night?
Do you get to sleep easily and rest well through the night?
How would you describe your overall energy?
Do you wake up feeling refreshed to start your day?
If there are energy fluctuations, when do you feel them?
Do you wake up feeling refreshed to start your day?
If there are energy fluctuations, when do you feel them?
On a scale of 1-10, how would you rate your stress level (1=very low; 10=very high)
Physical :- Personal/Emotional :- Mental/Career :-
List your 3 biggest sources of stress
Present method of handling the stress
How would you rate your experience with exercise?
Do you exercise regularly? (Household jobs are not exercises)
Your personal obstacles in adhering to an exercise program
Please list other physical activities you will be engaging in addition to this program
What is your available time and frequency for exercise?
Days :- Sunday Monday Tuesday Wednesday Thursday Friday Saturday 
Prior experience with any other fitness programmes:
How confident are you that you can add regular exercise into your daily schedule?
Any special consideration or request
Your expectation from our programme