Pre-Excercise - Better Shape

How did you find out about us?

Your Name*

First Name Last Name

Date Of Birth*

DD slash MM slash YYYY

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Occupation

Phone Number

Email Address*

Who should we contact in the case of an emergency?

First Name Last Name

Emergency Contact Phone

Do you suffer from any of the following?

Diabetes

Heart Condition

Asthma

Bone / Joint Problems

High / Low Blood Pressure

High Cholesterol

Epilepsy

Sports Injury

Cardiovascular Disease

Dizziness

Option A: DIRECT DEBIT - Bank Account

Financial Institution

BSB

Account Number

Account Name

Option B: DIRECT DEBIT - Credit Card

Credit Card

Visa

Mastercard

AMEX

Diners

Name On Card

Card Number

Expiry Date

CVV Security Number

I will inform Better Shape Fitness of any changes to my current medical condition*

Yes I Agree

For your own safety and well-being it is important that you inform us of any changes to your current medical condition. It is your responsibility to tell us what limitations you have. We are also very happy to work with your Doctor.

I agree to the Better Shape Fitness Terms and Conditions*

Yes I Agree

Please follow the link below to view our Terms and Conditions.

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Phone

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Client Pre-Exercise Form
Your health and well-being is our priority

Send us a message

Option A: DIRECT DEBIT - Bank Account

Option B: DIRECT DEBIT - Credit Card

Medical Form Downloads

Terms & Conditions

Client Pre-Exercise Form Your health and well-being is our priority

Send us a message

Option A: DIRECT DEBIT - Bank Account

Option B: DIRECT DEBIT - Credit Card

Medical Form Downloads

Terms & Conditions

Social Media

Client Pre-Exercise Form
Your health and well-being is our priority