Booking

Pilates4ladies Limited Health Questionnaire

Health Questionnaire
Booking

Full name

Date of birth

Mobile number

Email address

Emergency contact number

Address

If you answer ‘yes’ to any of the questions on this page, I recommend that you consult your GP before starting the course. The GP will advise you whether or not you should participate, thank you.

Q. Have you ever suffered from heart disease, high blood pressure or any other cardiovascular problems?

Q. Have you been troubled by chest pain, specifically if associated with minimal effort?

Q. Are you prone to headaches, fainting or dizziness?

Q. Do you suffer pain or limited movements in any joints? If ‘yes’, indicate any of the following:

Back

Knee

Neck

Hip

Other

Q. Are you pregnant or have you had a baby in the last 3 months?

Q. Are you on medications or do you have a medical condition or injury that you think may interfere with exercise participation? If ‘yes’, please explain:

Q. Have you had any operations in the last year? If ‘yes’, please explain:

Q. Are you a complete newcomer to exercise? If ‘no’, please describe your fitness level:

Q.Is there anything else your tutor should know?

Day

Time

Venue

Level

I have read and understood the disclaimer here and that the information given is correct.