2getfit Taster Session Questionnaire

Keep In Touch! We would like to keep you informed about whats happening with 2getfit, please tick below if your happy to hear from us.
Which Package are you enquiring about
How Did You Hear About us?
Date/Time You Require Your Appointment - (We may need to re-shedule depending on availability)
Free consultation Appointment - please choose day/time

MonthDayYearHourMinutesAM/PM Option
Pre Exercise Questionnaire
Name
E-mail
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Tel No
Name of Next of Kin
Next of Kin Tel No
Do You have Bone/Joint Problem
Do you have High Blood Pressure
Do You have Diabetes?
Do You have Asthma?
Do you have heart or lung Problems?
Is there a history of heart disease in the family?
Do You ever sufffer Pains in your chest?
Have you recently had an operation ?
Are you taking any prescribed medicines?
Taking Part in Our Program involves/Risk of injury/Death. Do you acknowledge that you take part at your own risk?
If you answered yes to any medical problems you need to see your Dr before your 1st session with us and seek clearance
Taking Part in Our Program involves the risk of injury - do you acknowledge that you take part at your own risk ?
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Keep In Touch! We would like to keep you informed about whats happening with 2getfit, please tick below if your happy to hear from us.