Individuals – Peak Preparation

Individual Athletes
Education
Corporates
Sporting Clubs
About

New Client Information Form - Individuals

We are committed to providing our clients with the best possible service. Please assist us by completing the following information.

Title

Firstname

Surname

Preferred Name

Date of Birth

Gender

Address

Suburb

State

Postcode

Phone

Mobile

Occupation

Regular Doctors Name

Clinic Name

Address

Phone

Coach Name

Coach Number

Please tick if you see any of the following on a regular basis (within a six-month cycle):

Psychologist
Chiropractor
Physiotherapist
Massage Therapist
Dietician
Podiatrist

Your Medical History

Please tick if you have or ever had any of the following…

Blood Pressure problems
Skin condition
Hepatitis / HIV
Sports injuries
High cholesterol
Bleeding Disorders
Diabetes
Neurological (nerve disorders)
Heart trouble
Asthma
Seizures
Poor healing
Arthritis
Stroke
Surgery
Ulcers

Meeting Your Needs

Please tick the services below that you are interested in from Peak Preparation:

Training Load Monitoring
Body Composition Monitoring
Sleep Strategies
Warm up and cool down strategies
Training Programs
Nutrition and Hydration Strategies
Recovery Strategies
Physiological and Performance Testing
Travel Tips
Presentations

How did you find out about Peak Preparation?

Please Read and Accept

DECLARATION: I understand and agree that:

If presentations need to be cancelled, I will give 3 days’ notice of the cancellation. If I do not cancel with notice, I will be charged a fee.
In the event that my accounts are outstanding longer than 45 days, I will be responsible for all collection fees incurred.
I am required to pay within 14 business days for all services.

Please calculate 7 plus 5

Peak Preparation Peak Preparation is based in Perth, WA however we work with clients Australia wide.

Social Media

Sectors

Individual Athletes Education Corporates Sporting Clubs

Contact

+61 404 884 521 sacha@peakpreparation.com.au

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