Health Questionnaire

Personal Details

Your Name (required)

How did you hear about us?

Your Email (required)

Who were you referred by? (if applicable)

Medical conditions

Do you have diabetes?
yesno

If yes, is it hypoglycaemia or hyperglycaemia?
hypoglycaemiahyperglycaemia

Do you have a heart condition or history of stroke? If yes, please provide details and discuss with your instructor.

Do you suffer from any joint problems eg. Arthritis, rheumatism or any cartilage issues? If yes, please provide details and discuss with your instructor.

Have you sustained a soft tissue injury in the past 3 months eg. hernia, muscle tear, ligament tear etc? If yes, please provide details and discuss with your instructor.

Have you undergone any operation in the past 3 months? If yes, please provide details and discuss with your instructor.

Do you suffer from asthma?
YesNo

If yes, do you have your inhaler with you?
YesNo

If you do not have your inhaler then please provide a reason

Are you pregnant or have you given birth in the past 3 months?
YesNo

Are you aware of any other medical conditions that could affect your training? If yes, please provide details and discuss with your instructor: