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Wellbeing Health Questionnaire
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Title
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First Name
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Mobile No.
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Surname
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Email
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Emergency Contact - Name
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Emergency Contact - Number
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How did you hear about us?
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What do you want to achieve?
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What fitness if any do you currently do?
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Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
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Yes
No
In the past month have you had chest pain whilst not doing physical activity?
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Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
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Yes
No
Is your doctor currently prescribing drugs for your blood pressure or heart condition?
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Yes
No
Do you suffer from Asthma or do you ever feel short of breath when resting or during mild activity?
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Yes
No
Do you feel pain in your chest when you do physical activity?
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Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
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Yes
No
Have you ever been told by your doctor that you have high blood pressure?
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Yes
No
Do you suffer from Diabetes or Epilepsy?
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Yes
No
Is there anything else not listed here that we need to know about which may mean you shouldn’t do physical activity?
DECLARATION
If I choose to take part in fitness classes delivered by SoFit I acknowledge that:
I am aware and understand the potential risks and dangers associated with physical activity and any equipment that may be used in a SoFit class and I am voluntarily participating in these activities with knowledge of the risks and dangers involved. I hereby agree and accept full responsibility for any injuries or death that may occur during a class.
I know of no reason why I should not participate in any of the activities at SoFit. I hereby declare myself free of any condition, illness or injury that may affect my participation. I agree to inform a member of staff if this changes at any point or if anything declared within the Health Questionnaire changes which may affect my ability to participate in SoFit sessions.
I agree to abide by any safety notices given to me during classes and am aware that I have the opportunity to ask questions about any of the activities, use of equipment or other session related issues. If I choose to listen to advice or notices given to me or if I choose to ignore them, I do so voluntarily and accept liability for any resulting injuries or damage.
I do hereby accept all responsibility or liability for any injuries or damages resulting from my participation in any activities that I take part in at SoFit.
I have read, understood and completed this questionnaire and agree to be bound by its conditions.
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Yes
No
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Name
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Date
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GDPR Agreement
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I agree to receive communication from SoFit by email and SMS once I begin my journey.
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Submit