How Healthy are you?

The road to better health starts right here.
"Yes, I'm interested in taking the first step toward
better health!"

Name

Address

Phone (H)

Phone (W)

Phone (M)

At Essence, our team of dedicated university qualified exercise physiologists are passionate about working with our members to ensure they really do achieve their health and fitness goals.

Long term and sustainable positive Lifestyle Change
is our focus and commitment to you, our valued members.

WHAT ARE YOUR TOP THREE HEALTH & FITNESS GOALS?
(Please number in order of importance)

Reduce body fat	Firm and tone up
Increase energy	Improve fitness
Improve self image	Look and feel good
Reduce blood pressure	Injury recovery

WHAT HAS KEPT YOU FROM STARTING SOONER?
No time
Lack of motivation
Finances
Fear of failure
Dislike of gyms

DO YOU HAVE A FAMILY HISTORY OF:
Chronic heart disease
High blood pressure
Diabetes
High cholesterol
Stroke

Send your answers

Please note that your contact details will only be used to contact you as you request, and will not be passed onto any other parties.