APSS Pre-Exercise Screening

Client Details

Full name

Date of birth

Sex

Stage 1

Compulsory

Aim: identify individuals with known disease, and/or signs or symptoms of disease, who may be at higher risk of an adverse event due to exercise.

Q7 — Current Activity

Weekly minutes

Describe your current physical activity in a typical week. Light: no noticeable change in breathing (RPE 1–2). Moderate: can hold a conversation (RPE 3–4). Vigorous/High: conversation difficult or impossible (RPE 5–7).

Intensity	Light	Moderate	Vigorous / High
Sessions per week
Total minutes per week

Weighted total = (light + moderate) + (2 × vigorous/high)

0 MIN / WEEK

Stage 2

Recommended — complete with your trainer

Aim: determine appropriate exercise prescription based on established risk factors. Flags below highlight thresholds from the APSS risk guidelines — they inform programming, they are not diagnoses.

8. Age

Risk of an adverse event increases with age (males ≥ 45 yr, females ≥ 55 yr)

9. Family history of heart disease (event in parents, grandparents, uncles/aunts before age 55)

10. Do you smoke daily/weekly, or have you quit in the last 6 months?

11. Body composition

Weight (kg)

Height (cm)

Waist (cm)

BMI (auto): — kg/m²

BMI ≥ 30 kg/m² increases the risk of chronic disease

Waist above threshold (>94 cm male / >80 cm female) increases risk of chronic disease

12. Have you been told you have high blood pressure?

Systolic (mmHg)

Diastolic (mmHg)

Systolic ≥ 140 or diastolic ≥ 90 mmHg increases the risk of heart disease

13. Have you been told you have high cholesterol / blood lipids?

Total cholesterol (mmol/L)

HDL (mmol/L)

LDL (mmol/L)

Triglycerides (mmol/L)

One or more lipid values exceed APSS thresholds (TC ≥ 5.2, HDL < 1.0, LDL ≥ 3.4, Trig ≥ 1.7 mmol/L)

14. Have you been told you have high blood sugar (glucose)?

Fasting glucose (mmol/L)

Fasting glucose ≥ 5.5 mmol/L increases the risk of diabetes

15. Currently taking any other prescribed medication(s)?

16. Hospital admission (incl. day admission) in the last 12 months?

17. Pregnant, or given birth within the last 12 months?

18. Any diagnosed muscle, bone, tendon, ligament or joint problem that could be made worse by exercise?

Declaration

I believe that to the best of my knowledge, all of the information I have supplied within this screening tool is correct.

Client signature (sign in the box below)

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Full name (printed)

Date

Personal Training Policies

Acknowledgement required

Cancellation / Rescheduling

If you need to cancel or reschedule a session, please call Michael Lea on 0414 183 715. If I'm not in, be sure to leave a message. I will check availability and get back to you with confirmation of the rescheduled date and time.

12 hours notice is required for a cancellation or rescheduling in order to receive credit for the session. Failure to cancel within this time frame, or failure to show up for a session, will result in the client being charged for the session. Exceptions will only be made in the case of a medical emergency accompanied by a doctor's note.

All sessions are to be paid cash upfront for the week.

Tardiness

Clients are expected to begin working out at the start time of the scheduled appointment. A late start does not entitle a client to a session longer than the scheduled appointment.

Expiration Dates on Packages

Any sessions that remain after the expiration date will be forfeited:

1 session — 1 month from date of purchase • 5 sessions — 2 months • 10 sessions — 3 months

I verify that I understand and will abide by these policies.

Client signature — policies (sign in the box below)

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