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DEMO STUDIO

DEMO STUDIO

F45 DEMO
PRE-EXERCISE SCREENING FORM

Please take a few minutes to answer the following questions so that we can ensure your success with us.

Contact Support

Pre-Exercise Screening Form

Please fill out the form below to request the cancellation of your membership. If you need help or would like to change memberships please reach out to us via our contact details below.

1Your Details

2Emergency Contact Details

3Medical Conditions Part 1

4Medical Conditions Part 2

5Current Exercise Routine

6Smoking & Allergies

7Goals & Acceptance

Name*
Date of Birth*
MM slash DD slash YYYY
Gender*
Gender*
Mobile*
Email*
Occupation

Emergency Contact Name*
Emergency Contact Mobile*

Please tick options that apply to you*
- Has a family member (under 60), suffered from heart disease, stroke, raised cholesterol or sudden death?
- Are you a male over 35 and NOT used to regular vigorous exercise?
- Are you on any prescribed medication?
- Are you pregnant?
- Have you given birth in the last 6 weeks?
- Do you have any infections or infectious diseases?
- None of the above

Please tick conditions that apply to you (Part 1)*
- Gout
- Stroke
- Diabetes
- Epilepsy
- Hernia
- Asthma
- None of the above
Please provide more details below
Please tick conditions that apply to you (Part 2)*
- Glandular Fever
- Rheumatic Fever
- Dizziness or Fainting
- Stomach/Duodenal Ulcer
- Liver or Kidney Condition
- Arthritis
- None of the above
Please provide more details below
Please tick conditions that apply to you (Part 3)*
- Any Heart Condition
- Heart Murmur
- High Blood Pressure (over 140/90)
- Palpitations or Pains in Chest
- Raised Cholesterol/Trigycerides
- Muscular Pain
- None of the above
Please provide more details below
Do you have any pain or major injuries in the following areas?*
- Neck
- Knees
- Back
- Ankles
- None of the above
Please provide more details below
Medical Acceptance*
I warrant that I am physically and mentally well enough to proceed with F45 Training sessions. Clients self-clearance of the above conditions.

Are you currently exercising regularly?*
- Yes
- No
How many times are you exercising per week?*
- 1
- 2 - 3
- 3 - 4
- 5+
What type of exercise are you currently doing?*

Do you smoke?*
- Yes
- No
How many do you smoke per day?*
- 1 - 5
- 6 - 10
- 11+
Are you allergic to anything?*
- Yes
- No
What are you allergic to?*

What are you 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
Marketing Acceptance*
I agree to allow F45 to use pictures, videos or the like for potential marketing material.
Statement*
I recognise that the instructor is not able to provide me with medical advice with regard 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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