Gym Health Questionnaire

GDPR

Below we will collect details about you and your health to ensure you are safe to begin your gym journey...
Any details you give will be kept by us to ensure your safety while in the gym environment.
Please answer the questions carefully and truthfully, otherwise your safety while using the gym might be affected.

Please fill out your details below...

Certain medical issues may indicate that you should not take part in exercise unless you have first obtained your doctor's approval.

If any of the following medical issues apply to you, let us know and we can determine if they are likely to be a problem.

For some medical issues like diabetes or high blood pressure, if you are managing your issues that is normally no reason to stop you attending :)

Title

Fullname

Address

Date of Birth

Mobile

Emergency Contact

Emergency Number

Please confirm the following questions...

I do not have any heart conditions and my doctor has never told me to only exercise as part of any medically supervised programme

I have never lost consciousness or fallen over as a result of dizziness

I do not experience any form of chest pain at rest or while active

I have never been diagnosed with a severe bone or joint problem that could be made worse by exercising

I am not currently prescribed any medication for high blood pressure, a heart condition or other serious illness

I am not pregnant or have given birth in the last 3 months

There are no other reason, not mentioned above, that require me to only exercise in a medically superivsed programme (eg. uncontrolled diabetes or epilepsy)

Tick here if you would like to opt out of having an induction and are happy to sign a gym usage waiver

I declare I have read and fully understand this Pre-Exercise Questionnaire and confirm that the answers given by me are correct and not misleading. I know of no reason why I should not participate in any form of exercise or any other activity.

Signed:

Re Captcha

By registering you are agreeing to allow us to process your data for the express purposes set out above.

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