• Please read and answer the questions on this form carefully and honestly by ticking YES or NO and giving further details where necessary. It is important that you consider your medical history and any present injuries before participating in any form of exercise or massage therapy or any other treatments including but not limited to the Sauna & Cold Pool facitity. 

    If you answer ‘YES’ to one or more of the questions, please speak to your GP/Medical Professional before attending your first session or accept self-certification and responsibility to safely participate.

  • Has you GP ever said that you have a heart condition and recommended that you only do medically supervised activity?*
  • Do you have chest pains brought on by physical activity?*
  • Do you have high or low blood pressure?*
  • Do you suffer from heart disease or angina?*
  • Are you on any form of medication?*
  • Are you recuperating from an operation or from a recent illness?*
  • Do you suffer from dizziness, fainting, headaches or do you ever lose consciousness?*
  • Do you suffer from Asthma, Diabetes or Epilepsy?*
  • Do you have a bone or joint problem that could be aggravated by exercise?*
  • Do you suffer from any form of back problem?*
  • Are you or have you recently been pregnant?*
  • Do you have any allergies?*
  • Do you know of any other reason why you should not do physical activity?*

  • Please note our services do not serve as a substitute for professional medical advice, examination, diagnosis, or treatment. We do not claim to cure or diagnose any medical condition and that we do NOT give professional medical advice. Please seek the advice of your doctor or other qualified health provider with any questions you may have regarding a medical condition.  You should never disregard professional medical advice or delay in seeking it.

    If you have a health problem, medical emergency, or a general health question, we recommend that you should consult a doctor.

    Declaration

    Please read and sign the declaration below:

    Terms & conditions: 

    I hereby state I have read and agree to the terms & conditions stipulated by Studio Ninety Five Ltd. (https://studioninetyfive.uk/terms-conditions) 

    I confirm that the above information is, to the best of my belief, correct. I have informed the instructor/practitioner of all relevant medical information. I will inform the instructor/practitioner of any changes in my state of health/medications. Whilst exercising, I will stop and immediately inform the instructor if I experience chest pain, nausea, dizziness, undue breathlessness, or if I feel unwell in anyway. I realise and accept that there is a risk associated with undertaking any exercise programme or sports massage.  

  • Date*
     - -

  • (additional note: I have taken medical advice and my doctor has agreed that I should exercise) 

  • Should be Empty: