Please fill out the health sheet to the best of your knowledge

Full Name *

Phone *

Email *

Date of birth *

PLEASE COMPLETE OUR MEMBERSHIP APPLICATION FORM AND LET’S GET YOU FIGHTING FIT!

Has a doctor / medical professional ever diagnosed you with a heart condition and indicated you should restrict your physical activity? *

Yes

No

When you were not engaging in physical activity, have you experienced chest pain in the past month? *

Yes

No

Do you ever faint or get dizzy and lose your balance? *

Yes

No

Do you have high blood pressure or a heart condition in which a doctor / medical professional is currently prescribing a medication? *

Yes

No

When you perform physical activity, do you feel pain in your chest? *

Yes

No

Are you pregnant? *

Yes

No

Do you know of any other reason you should not exercise or increase your physical activity? *

Yes

No

Do you have insulin dependent diabetes? *

Yes

No

Emergency Contact Name *

Emergency Contact Number *

By providing my phone number, I agree to receive text messages from the business.

*

The Information provided is accurate and to the best of my knowledge