Intake Form (Self-Guided Programme)

Complete the form below to get started with your program ASAP. It should only take 3-5 minutes.

"*" indicates required fields

Name*

First Last

Email*

The email address you purchased with (Note: this will be your username for logging in too)

Where are you now?

Age*

Just a number.

Please enter a number from 18 to 99.

Height*

Select from the drop down box.

Weight in Kg*

Must be in kilograms without units e.g. 80.1. Click here to see stone to kg conversion table (opens in new window).

Please enter a number from 40 to 200.

Dress size*

If you’re between two, pick the bigger of the two as it gives you more room for improvement 🙂

How many workouts are you used to doing per week?*

None

1-2

3-4

More than 4

What's your average daily step count been over the past month?

Check either the health app on your phone or smart watch if you have one. If you don’t know, leave this blank.

Please enter a number from 0 to 50000.

Do any of the following apply to you?

Tick all that apply.

Polycystic ovary syndrome (PCOS)

Underactive thyroid (hypothyroidism)

History of eating disorders

Perimenopause

Menopause

Hysterectomy

Type 1 diabetes

Type 2 diabetes

Are you taking HRT?*

Yes

Health Assessment

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*

Yes

Do you feel pain in your chest when you do physical activity?*

Yes

In the past month, have you had chest pain when you were not doing physical activity?*

Yes

Do you lose your balance because of dizziness or do you ever lose consciousness?*

Yes

Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*

Yes

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart conditions?*

Yes

Do you know of any other reason why you should not do physical activity?*

Yes

If you answered YES to one or more questions:
– Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.
– You may be able to do any activity you want as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice find out which community programmes are safe and helpful for you.

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
– Start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go.
– Take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active.

Digital Signature*

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

First Last

Terms & Conditions

By signing up for the Fit Over 40 Self-Guided Programme, I confirm that I understand and agree to the following:

1. My data will be securely stored and used only for communication between myself and the TRINITY team.

2. My data will never be shared with third parties.

3. This is a self-guided online programme delivered remotely – not in person.

4. This programme does not guarantee results, including weight loss or health improvements.

5. The programme materials are for my personal use only. Sharing them with others is strictly prohibited and may lead to legal action.

6. Programmes are non-refundable once any personalised content (including email support, custom nutrition targets, or access to streaming videos) has been delivered or made available. This complies with the Consumer Contracts Regulations 2013.

7. Programmes cannot be paused. You are expected to continue working on your nutrition and lifestyle even during holidays, minor illness/injury, busy periods, or family challenges.

8. This is a rolling monthly subscription. Your payments will continue until you request cancellation in writing and complete the cancellation form (available via the Support button in your online programme at any time). Your monthly fee will not increase as long as you remain a member.

9. I have read and agree to the full terms and conditions at: https://trinitytransformation.co.uk/self-guided-terms-and-conditions

Digital Signature*

I have read, understood and agree to the Terms & Conditions of this programme.

First Last

How you found TRINITY

Where did you first hear about TRINITY?*

Ad on YouTube

TikTok

Facebook

Instagram

Google search

From a friend

Other

What influenced you to join TRINITY?

Tick ALL that apply

Friend’s recommendation

Our daily emails

TRINITY podcast

Our Instagram posts

Our Facebook posts

Our TikTok posts

What's the full name of the friend who referred you to join Trinity?*

Where are you now?

Health Assessment

Terms & Conditions

How you found TRINITY

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