Exercise Unlocked Exercise Physiology
Home
What Is An Exercise Physiologist?
Services
Exercise Physiology
Relaxation Massage
Boxing Training
Assisted Stretching
Bootcamp Alternative
>
Pre-Exercise Form
Get In Touch!
Fitness Vlog
Free Stuff!
>
Prevent Osteoporosis Program
FREE Over 50's Guide
Free Stretching Chart
Members Area
Exercise Demonstrations
Home Workouts
Stretching Videos
Injury Recovery
This pre-exercise form
must be completed and submitted before anybody can commence exercise activities with us.
*
Indicates required field
Name
*
First
Last
Phone Number
*
Address
*
Email
*
Date of Birth
*
Occupation
*
Has your doctor or surgeon ever told you that you have a heart condition or have you ever suffered a stroke?
*
Yes
No
If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?
*
Yes
No
Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?
*
Yes
No
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
*
Yes
No
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
*
Yes
No
Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?
*
Yes
No
Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?
*
Yes
No
Please feel free to leave a message for us
*
This screening tool does not provide advice on a particular matter, nor does it substitute for advice from an appropriately qualified medical professional. No warranty of safety should result from its use. The screening system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by David Hagger or his team for any loss, damage or injury that may arise from any person acting on any statement or information contained in this tool or participation in exercise activities administered by David Hagger, including it's Directors, employees and contractors.
Photographs and videos are sometimes taken at classes for promotional purposes.
I have read, understood and agree with the above statement and believe that to the best of my knowledge, all of the information I have supplied within this form is correct.
Name
*
First
Last
Date
*
Submit
Home
What Is An Exercise Physiologist?
Services
Exercise Physiology
Relaxation Massage
Boxing Training
Assisted Stretching
Bootcamp Alternative
>
Pre-Exercise Form
Get In Touch!
Fitness Vlog
Free Stuff!
>
Prevent Osteoporosis Program
FREE Over 50's Guide
Free Stretching Chart
Members Area
Exercise Demonstrations
Home Workouts
Stretching Videos
Injury Recovery