Health Screen Form

  • Contact Details

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  • Are you active on a daily basis?*
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  • Were you referred to us by one of our clients?*

  • Pre & Post Natal

  • Are you pregnant?*
  • If yes, do you have a medical clearance to exercise?
  • Have you had a baby in the last 6 weeks - 6 months? If yes do you have a medical clearance to exercise?

  • Medical History

  • Have you ever suffered from...?
  • Have any of your first degree relatives experienced the following conditions?
  • Have you had surgery in the last two years?
  • Do you suffer from back pain?
  • Do you have any injuries?
  • Do you smoke?

  • Please Read The Following T&C's.

  • 1.) CANCELLATIONS Cancellations should be made at least 12 hours in advance of a scheduled session. Sessions cancelled less than 12 hours in advance will be charged in full to the client.

    2.) LATE ARRIVALS Each session will be 45min in length. Sessions will not be extended due to lateness or interruptions caused by the client.

    3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT All the information on this form is correct and to the best of my knowledge. If I have answered YES to any of the above questions I will seek and follow any medical advice. I understand that all the information given will be kept confidential.

    4.) I'm physically capable and there are no medical conditions to prevent me from proceeding with exercising with Stefitness. I acknowldge that I will not hold Stefitness accounatble for injury, damage or loss of property.

  • I AGREE to the above terms and conditions.*
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