Health Screening Questionnaire for Classes and One to One sessions
The information provided on this form will be kept in the strictest confidence for centre use only and will assist the Natural Fitness and Therapies in providing the best service we can. We do not share your information with anyone.
Full Name *
Date of Birth
Phone Number
In order for us to send you emails regarding your classes you will need to subscribe to our newsletter. You can unsubscribe at any time, do you agree? (Please note that you will never receive any correspondence from us if you tick no.) *
How did you hear about us?
Clear selection
Do you have any of the following?
Are you undergoing any treatment for pain or injury and if so for what and which treatment?
Are you taking medication? Is so what?
Do you have any other health issues that may affect you taking part in an exercise class?
Do you currently take exercise? If yes, what do you do?
If doing pilates, what do you wish to achieve?
Name and phone number of a contact in case of emergency : *
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