Client Details

YYYY slash MM slash DD
Phone Number *
Emergency Contact Name
Emergency Contact Name
How did you hear about Team Impaact?*

Training History

I am*
Currently Exercising?*
Times Per Week?*
Achieving Results*
Do You Like To Train In The Morning Or Afternoon?*


Do you have a stressful job?*
Do you drink alcohol?*
Do you smoke?*
Do you drink coffee?*
Food Intolerance?*
1 = poor, 10= good


High blood pressure?*
Chest Pain*
Back Pain*
Heart trouble/history*
Faint or dizzy spells*
Sports injury*
Bone or joint problem*


Weight Loss
Would you like to achieve these?

What are your 3/6/12 month goals?

Are you willing to commit to the process for the next 6 months?*
Are you 100% committed to achieving your why?*
Are you willing to make sacrifices in order to achieve your why?*
Personal Barrier Please Check*
Is this still a problem?*
Do you have support from your friends and family?*

Terms & Conditions

1st Session Comfort Guarantee

If you change your mind, you can terminate this agreement within 48hrs after your first paid Group and PT session with Team Impaact. Email and we will cancel all future payments and refund to you within 14 days any monies paid via banking transfer into your nominated account.

Suspension and Cancellation Policy - Within Minimum Term

All membership options give you the ability to suspend your membership at no extra charge for a minimum of 2 weeks and up to a maximum of 1 month during your minimum term. We require 7 business days before your next payment date to suspend your membership.

If you cancel your membership within the minimum term there is an upfront 100% cancellation fee of your remaining payments. We also require 14 business days before your payment date to cancel your membership.

You can terminate the agreement due to sickness or physical incapacity at no extra charge, however, you must supply a medical certificate.

5 Hour Cancellation Policy

Should I cancel a personal training session with less than 5 business hours notice, I acknowledge that the session is forfeited and full - training fees applies. For Monday morning sessions I will leave a message on Sunday. When I give 5 hours notice I acknowledge that rescheduling my appointment to a more convenient time at no charge, will be pending on availability of training times.

After Your Minimum Term

Your membership is ongoing after your minimum term (24 weeks) so no changes will be made unless you notify us via email. After your minimum term, you can suspend or cancel your membership with no cancellation fee by providing 14 business days notice prior to your next payment date via email. You have a maximum of 6 weeks per year to have your membership placed on hold.

  1. Understand that I am entering into an agreement for a minimum term of 24 weeks during which i will be debited on a fortnightly basis for the selected service, as per the ezidebit agreement.
  2. I have read, understand Team Impaacts terms and conditions.
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Acceptance of risk*
I have read the acceptance of risk provision in this agreement and I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am singing the agreement freely and voluntarily and intend, by my signature that this document is completed and an unconditional release of liability to the greatest extent allowed by law.
  1. The information given by me in this safety questionnaire is true, complete and accurate and I understand the advice given above.
  2. I have obtained clearance from a medical professional where required or recommended.
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