DJ's GYM Health Questionnaire
Regular physical activity is beneficial to everyone. However, some people are slightly more at risk than others and may need to consult a health professional before starting an exercise program.

To help us determine whether or not you are at risk, please answer the following questions, to the best of your knowledge, as honestly and with as much detail as possible.

All information on this sheet is confidential. Please check YES or NO.

TERMS & CONDITIONS

• Must be a first time user of DJ Gym
• Not valid for current or former members of DJs Gym (this includes any previous trials or guest pass)
• Access during Staffed Hours only
• DJs Gym reserves the right to cancel any 7 Day Pass not meeting these criterias
• Trial days are to be used consecutively. If you are unable to visit the gym during your trial or if trial days fall on a public holiday, we are unable to award extra days for these reasons. So please plan your trial sign up carefully.

How did you hear about us? *
Required
Name (First name, Surname) *
Date of birth *
Phone number *
Email *
ID number (eg. Passport, Drivers License, Medicare). Please provide a valid number. *
Emergency contact person *
Phone number *
Has your doctor ever told you that you have a heart condition, or have you ever had a stroke? *
Required
If yes, please describe.
Have you ever experienced unexplained pains in your chest at rest, or during physical activity? *
Required
If yes, how often does this occur?
Do you have any diagnosed muscle, bone or joint problem that you have been told by a health professional that may be worsened through exercising? *
Required
If yes, please describe.
Do you ever feel faint or have dizzy spells that cause you to lose your balance during physical activity or exercise? *
Required
Have you ever had an asthma attack requiring medical attention anything within the last 12 months? *
Required
If you are a diabetic, have you had trouble controlling your blood glucose level within the last 12 months? *
Required
Do you have any other medical conditions that you have been told by a health professional that will make it dangerous for you to participate in physical activity or exercise? *
Required
Have you completed this questionnaire honestly and with full understanding. *
Required
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