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07962 532 231

H SUSAN GARDNER PT

"Investing in your bodies future"!

Medical Questionnaire

Please fill out the following form to help us understand your physical condition.

First Name

Email Address

Last Name

Date of Birth

Have you been hospitalized in the last 12 months?

Yes

Are you currently suffering from a medical condition, illness, or injury?

Yes

If you answered yes to any question, please elaborate

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Health Declaration

Please fill out the following health declaration form in order to participate in our activity. Submissions are valid up to 24 hours prior to the activity.

First Name

Last Name

My body temperature is lower than 98.6°F/ 37.5°C

Are you experiencing any flu symptoms?

Yes

Date

Initials

I confirm that the information given in this form is true

Thanks for submitting!

Write a Review

First Name

Last Name

Phone

Rate Our Services

Excellent

Good

Disappointing

What did you like best?

How can we improve?

Would you recommend us to your friends?

Yes

Anything else you would like to add?

Thanks for submitting!

personal training Waiver

To register for Personal Training please fill out the following medical form

First Name

Email Address

Last Name

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

Yes

Have you lost your consciousness in the last past 12 months?

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

07962 532 231