Health Questionnaire

Health Questionnaire

All About Fitness - Pre-Exercise Screening
Anyone who has an existing medical condition, or who has not exercised for 6 months or more, is advised to seek medical clearance before starting an exercise program. It is not the responsibility of All About Fitness to make sure you are cleared for exercise. It is also advised to alert All About Fitness of any changes to your current/future medical status. All About Fitness are available to discuss any of your conditions with you, confidentially, but will NOT be able to give medical advice. Participation is at the discretion of the individual. All About Fitness reserves the right to refuse participants in some instances.
Full Name

First NameLast Name
E-mail Address
example@example.com
Contact Number
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Date of Birth

DayMonthYear
Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.
Do you have any allergies?

YesNo
If yes, please elaborate:
Are you or have you recently been pregnant?

YesNo
Do you currently, or have you ever had any of the following medical conditions:
Heart trouble?

YesNo
High blood pressure?

YesNo
Dizzy spells?

YesNo
High cholesterol?

YesNo
Arthritis?

YesNo
Asthma?

YesNo
Epilepsy?

YesNo
Hernia?

YesNo
Osteoporosis?

YesNo
Back problems?

YesNo
Muscle problems?

YesNo
Diabetes?

YesNo
Please provide any details for anything you have clicked 'Yes' on:

Do you currently, or have you ever had any of the following medical conditions: