Willoughby Challenge - Pre-Exercise Screening
This form will be used to gather important information that your trainer will need to know prior to the commencement of your first program. This information will be stored in a secure location, accessible to only ExMed staff and not released without your written consent.
By completing the following form, you agree that all information provided is correct to the best of your knowledge. You acknowledge that ExMed practitioners require a correct medical & exercise history, in conjunction with additional information provided, to properly determine your suitability to exercise and any potential risks that warrant consideration under our guidance. *
Full Name: *
Your answer
Date of Birth: *
Email: *
Your answer
Mobile Number: *
Your answer
Marital Status:
Your answer
What do you currently do for work?
Your answer
How did you find out about this challenge?
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