AW Pink Training Health Screen
Your health screen is confidential and will only be shared with relevant instructors for safety reasons and to assist in planning options for any injuries.

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Full Name / Nickname / Preferred pronoun *
Age
DOB
MM
/
DD
/
YYYY
Address *
Mobile *
Email *
Emergency Contact Name *
Emergency Contact Number *
Do you have or have you ever experienced any of the following: *
Required
Please describe any injuries below:
Do you have a family history of heart disease or stroke of relatives under the age of 65?
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Have you ever had any major surgery? If yes, please describe below: *
Are you currently on any medication(s)? *
Do you have any pelvic floor issues? *
Comments:
Almost done! Please agree to our Conditions of Participation. You can find our terms and conditions for both Live Stream + Studio sessions here: bit.ly/boringbits *
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