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DEMO Pre-Exercise Screening Form
Please take a few minutes to answer the following questions so that we can ensure your success with us.
Date of Birth
Emergency Contact Name
Emergency Contact Phone Number
Medical Considerations (Part I)
Has a family member (under 60), suffered from heart disease, stroke, raised cholesterol or sudden death
Are you a male over 35 or over 45 and NOT used to regular vigorous exercise?
Are you on any prescribed medication?
Have you been hospitalised recently?
Are you pregnant?
Have you given birth in the last 6 weeks?
Do you have any infections or infectious diseases?
Medical Considerations (Part II)
Dizziness or Fainting
Liver or Kidney Condition
Any Heart Condition
High Blood Pressure (over 140/90)
Palpitations or Pains in Chest
Do you have any Pain or Major Injuries in the following areas:
If you ticked any of the above please provide more details below.
I warrant that I am physically and mentally well enough to proceed with Body Fit Training sessions. Clients self-clearance of the above conditions.
Are you currently exercising regularly?
If yes, please give details:
Frequency of exercise (times per week):
2 - 3
3 - 4
Do you smoke?
If yes, how many per day?
1 - 5
6 - 10
Are you allergic to anything?
What are your goals?
To reduce body fat
To improve aerobic capacity (heart / lung fitness)
To gain some muscle definition
To gain overall fitness
To generally tone up
To gain strength
I agree to allow Body Fit to use pictures, videos or the like for potential marketing material
I recognise that the instructor is not able to provide me with medical advice with regards to my fitness, and that this information is used as a guideline to the limitations of my ability to exercise. I have answered questions to the best of my ability and understand the advice above.
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