New client

HEALTH & MEDICAL HISTORY

CONTACT ME

Personal details

Medical questions

Please answer the following questions as honestly as you can and provide as much relevant additional information. Answer the following questions by placing a tick in either Yes or No boxes (if you should answer Yes to any of the questions please provide further information in the space provided)

Do you currently or have you ever suffered from any of the following conditions?

Medical history

Do you currently receive medical care or do any of the following affect you?

Declaration

I have answered all questions in this form honestly and I am aware that if I have answered 'Yes' to some of the questions I may need to consult my GP before commencing an exercise program. I agree to inform my personal trainer on any changes in health or fitness. I agree to assume full responsibility for any risks, injuries or damages which I might incur as a result of participating in a regular exercise routine. I understand that I am able to stop exercising at any time and will be honest with my trainer at all times.

Please tick below to show you have read and agree *
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