SeniorFit Personal Training
Empowering Lifelong Independence
212-677-6131 New York City info@seniorfitnyc.com
We Come To Your Home - Office - Gym
Serving New York City 212-677-6131
CALL 212-677-6131
SENIOR FITNESS EXERCISE
Personal Training For Seniors
APPOINTMENT SCHEDULE
APPOINTMENT LOCATION
EASY PAYMENT
SIGN ME UP NOW
I NEED MORE INFORMATION
Personal Training For Seniors
- Strength
- Balance
- Flexibility
- Cardiovascular
- Agility
- Tai Chi from The Arthritis Foundation
- Yoga For Older Adults
- Pilates For Older Adults
- Meditation
- Reiki
APPOINTMENT SCHEDULE
- Appointments can be scheduled Monday through Friday, between the hours of 7:00 A.M. and 4:00 P.M.
APPOINTMENT LOCATION
- Appointments are scheduled in your gym, home, office, or outdoors.
EASY PAYMENT
- Payment is made by personal check at the time of your appointment.
- For clients who take multiple sessions, you may pay weekly, if you prefer.
- Deposits are not required. There are no contracts.
SIGN ME UP NOW
I NEED MORE INFORMATION
CALL 212-677-6131
GET STARTED WITH SENIOR EXERCISE
Take The First Step Toward Better Health!
To sign up you'll need to fill out The Health History Profile, read and sign the Client Consent. The Physician Consent form should be signed by your doctor.
STEP ONE
Call 212-677-6131 to request your sign-up forms. They will be forwarded to you by email, fax, U.S. Mail, or dropped off by messenger in your building, whichever you prefer. The forms can be viewed by scrolling to the bottom of this page.
STEP TWO
Submit your sign-up forms.
STEP THREE
Schedule your one-hour free consultation.
After you submit your sign-up forms, and have had your consultation, you are ready to begin personal training.
CALL 212-677-6131
PRICES
Introductory Prices For New Clients
Personal Training - $105.00 Per Hour
You can take up to 4 introductory sessions within a 30 day period. Payment is due at the time of your session by personal check.
Personal Training for Two - $70.00 Per Hour, Per Person
Two people, who want Buddy Workouts can take up to 4 introductory sessions within a 30 day period. Payment is due at the time of your session by personal check.
Regular Prices
Personal Training - $125.00 Per Hour
You can schedule 1, 2, or 3 personal training sessions per week. Payment is due at the time of your session by personal check.
Personal Training for Two - $90.00 Per Hour, Per Person
Two people, who want Buddy Workout Personal Training, can schedule 1, 2, or 3 sessions weekly. Payment is due at the time of your session by personal check.
Introductory Prices For New Clients
Personal Training - $105.00 Per Hour
You can take up to 4 introductory sessions within a 30 day period. Payment is due at the time of your session by personal check.
Personal Training for Two - $70.00 Per Hour, Per Person
Two people, who want Buddy Workouts can take up to 4 introductory sessions within a 30 day period. Payment is due at the time of your session by personal check.
Regular Prices
Personal Training - $125.00 Per Hour
You can schedule 1, 2, or 3 personal training sessions per week. Payment is due at the time of your session by personal check.
Personal Training for Two - $90.00 Per Hour, Per Person
Two people, who want Buddy Workout Personal Training, can schedule 1, 2, or 3 sessions weekly. Payment is due at the time of your session by personal check.
CALL 212-677-6131
IMPORTANT NOTICE
The American College of Sports Medicine (ACSM) recommends medical clearance from a physician for men over 40, and women over 50 years of age. It is in your best interest to be sure you have taken this important step before beginning a personal training program.
THIS FORM CANNOT BE FILLED OUT ONLINE.
WE WILL EMAIL, FAX, DROP-OFF, OR MAIL IT TO YOU.
www.seniorfitnyc.com 212-677-6131
HEALTH HISTORY PROFILE
HEALTH HISTORY PROFILE
NAME____________________________________________________________
DATE____________________________________________________________
HOME PHONE______________________ WORK PHONE___________________
ADDRESS_________________________________________________________
AGE__________HEIGHT____________________WEIGHT___________________
DO YOU CURRENTLY EXERCISE?________________________________________
WHAT TYPE OF EXERCISE?____________________________________________
WHAT WOULD YOU LIKE TO ACCOMPLISH? CIRCLE YOUR ANSWER.
Improve Strength Improve Flexibility Improve Cardio Improve Balance
Learn Tai Chi Learn Yoga Learn Pilates Lose Weight Improve Health
MEDICAL HISTORY
Do you have any physical condition, impairment, or disability that might affect your ability to begin, and maintain a regular exercise program? Please briefly explain.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Do you frequently experience any of the following. Circle your answers.
Chest Pains Lightheaded Breathless Ankle Swelling Dizziness Faint
Are you under the care of a doctor? Yes No Date of Last Physical__________
Do you smoke? Circle your answer. Yes No
MEDICATION - Circle medication you take on a regular basis.
Heart Insulin Pain Reliever Blood Pressure Asthma Cholesterol
CARDIOVASCULAR - Use check mark. Use lines for brief explanation if needed.
High Blood Pressure_________________________Reading___________________
High Cholesterol_____________________________________________________
Heart Disease_______________________________________________________
Heart Attack________________________________________________________
ORTHOPEDIC - Use check mark. Use lines for brief explanation if needed.
Osteoarthritis_______________________________________________________
Knee Surgery/Replacement____________________________________________
Hip Surgery/Replacement______________________________________________
Joint Discomfort/Pain_________________________________________________
Limited Joint Mobiity__________________________________________________
Rheumatoid Arthritis__________________________________________________
DIABETES - Use check mark. Use lines for brief explanation if needed.
Type 1_____________________________________________________________
Type 2_____________________________________________________________
PULMONARY - Use check mark. Use lines for brief explanation if needed.
Emphysema_________________________________________________________
Episodic Asthma______________________________________________________
Chronic Bronchitis____________________________________________________
OTHER INFORMATION
Add any comments, concerns, or questions you have in relation to your exercise needs.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Name of emergency contact_____________________Relationship_________________
Work Phone__________________________Business Phone_____________________
DATE____________________________________________________________
HOME PHONE______________________ WORK PHONE___________________
ADDRESS_________________________________________________________
AGE__________HEIGHT____________________WEIGHT___________________
DO YOU CURRENTLY EXERCISE?________________________________________
WHAT TYPE OF EXERCISE?____________________________________________
WHAT WOULD YOU LIKE TO ACCOMPLISH? CIRCLE YOUR ANSWER.
Improve Strength Improve Flexibility Improve Cardio Improve Balance
Learn Tai Chi Learn Yoga Learn Pilates Lose Weight Improve Health
MEDICAL HISTORY
Do you have any physical condition, impairment, or disability that might affect your ability to begin, and maintain a regular exercise program? Please briefly explain.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Do you frequently experience any of the following. Circle your answers.
Chest Pains Lightheaded Breathless Ankle Swelling Dizziness Faint
Are you under the care of a doctor? Yes No Date of Last Physical__________
Do you smoke? Circle your answer. Yes No
MEDICATION - Circle medication you take on a regular basis.
Heart Insulin Pain Reliever Blood Pressure Asthma Cholesterol
CARDIOVASCULAR - Use check mark. Use lines for brief explanation if needed.
High Blood Pressure_________________________Reading___________________
High Cholesterol_____________________________________________________
Heart Disease_______________________________________________________
Heart Attack________________________________________________________
ORTHOPEDIC - Use check mark. Use lines for brief explanation if needed.
Osteoarthritis_______________________________________________________
Knee Surgery/Replacement____________________________________________
Hip Surgery/Replacement______________________________________________
Joint Discomfort/Pain_________________________________________________
Limited Joint Mobiity__________________________________________________
Rheumatoid Arthritis__________________________________________________
DIABETES - Use check mark. Use lines for brief explanation if needed.
Type 1_____________________________________________________________
Type 2_____________________________________________________________
PULMONARY - Use check mark. Use lines for brief explanation if needed.
Emphysema_________________________________________________________
Episodic Asthma______________________________________________________
Chronic Bronchitis____________________________________________________
OTHER INFORMATION
Add any comments, concerns, or questions you have in relation to your exercise needs.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Name of emergency contact_____________________Relationship_________________
Work Phone__________________________Business Phone_____________________
THIS FORM CANNOT BE FILLED OUT ONLINE.
WE WILL EMAIL, FAX, DROP-OFF, OR MAIL IT TO YOU.
www.seniorfitnyc.com 212-677-6131
Irene Pastore, ISSA, NASM
Certified Personal Trainer, Certified Specialist in Fitness For Older Adults
CLIENT CONSENT
I understand that it is my responsibility to check with my physician to ensure that I have no medical condition that contraindicates my participation in SeniorFit Personal Training. I understand that if my medical condition changes, and that exercise is contraindicated by my doctor, it is my responsibility to inform my personal trainer, and discontinue my participation in the program.
I have completed the Health History Profile indicating disease, and/or orthopedic conditions diagnosed by my physician. I know of no medical problem, that would increase my chance of injury or illnesss as a result of my participation in an exercise program.
I acknowledge that it is my responsibility to inform my personal trainer if I need to refrain from any particular exercise that I do not feel comfortable, or capable of performing, or that my physician has advised against. I agree to inform my personal trainer of any change in prescription medication that may affect my ability to exercise.
I understand that while every precaution will be taken to avoid risk of injury, there are risks of injury inherent in any type of exercise, and that I assume full responsibility relative to my participation in a personal training program.
I have carefully read, and understood the above, and give my consent to participate in SeniorFit Personal Training.
Signature___________________________________________Date____________
Print Name_________________________________________________________
Home Address______________________________________________________
Home Phone____________________________Work Phone__________________
I have completed the Health History Profile indicating disease, and/or orthopedic conditions diagnosed by my physician. I know of no medical problem, that would increase my chance of injury or illnesss as a result of my participation in an exercise program.
I acknowledge that it is my responsibility to inform my personal trainer if I need to refrain from any particular exercise that I do not feel comfortable, or capable of performing, or that my physician has advised against. I agree to inform my personal trainer of any change in prescription medication that may affect my ability to exercise.
I understand that while every precaution will be taken to avoid risk of injury, there are risks of injury inherent in any type of exercise, and that I assume full responsibility relative to my participation in a personal training program.
I have carefully read, and understood the above, and give my consent to participate in SeniorFit Personal Training.
Signature___________________________________________Date____________
Print Name_________________________________________________________
Home Address______________________________________________________
Home Phone____________________________Work Phone__________________
THIS FORM CANNOT BE FILLED OUT ONLINE.
WE WILL EMAIL, FAX, DROP-OFF, OR MAIL IT TO YOU.
www.seniorfitnyc.com 212-677-6131
Irene Pastore, ISSA, NASM
Certified Personal Trainer, Certified Specialist in Fitness For Older Adults
PHYSICIAN CONSENT
Your patient would like to participate in a program of physical activity that includes items checked below.
Muscular Strengthening_____
Flexibility_____
Cardiovascular Exercise_____
Balance Training_____
Tai Chi Exercise_____
Over 50 Modified Yoga_____
Over 50 Modified Pilates_____
PATIENT NAME______________________________________________________
ADDRESS__________________________________________________________
PLEASE CHECK ONE
I give my patient approval to participate in SeniorFit Personal Training without restrictions._____
I give my patient approval to participate in SeniorFit Personal Training with restrictions, and/or recommendations._____
RESTRICTIONS AND/OR RECOMMENDATIONS FOR MY PATIENT
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Muscular Strengthening_____
Flexibility_____
Cardiovascular Exercise_____
Balance Training_____
Tai Chi Exercise_____
Over 50 Modified Yoga_____
Over 50 Modified Pilates_____
PATIENT NAME______________________________________________________
ADDRESS__________________________________________________________
PLEASE CHECK ONE
I give my patient approval to participate in SeniorFit Personal Training without restrictions._____
I give my patient approval to participate in SeniorFit Personal Training with restrictions, and/or recommendations._____
RESTRICTIONS AND/OR RECOMMENDATIONS FOR MY PATIENT
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Office Address________________________________________Phone__________
