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To register to our gym please fill out the following medical form
Date of Birth
Emergency contact name
Emergency contact number
Has your doctor advised that you should not participate in physical activity or exercise?
Are you pregnant or post natal?
Do you suffer from asthma or breathing difficulties?
Have you been in hospital in the last 3 years?
Are you taking any medication?
Do you suffer from diabetes or epilepsy?
Has your doctor ever said that you have a heart condition and that you should only participate in physical activity recommended by a doctor?
Do you feel pain in your chesst when you do physical activity?
Do you lose your balance because of dizziness or do you ever lose conciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Is your doctor prescribing drugs for your blood pressure or heart condition?
Do you know of any other reason why you shouldn't participate in physical activity?
Do you require an induction?
If you answered YES to any of the above questions, please provide more information:
I declare that the info I’ve provided is accurate & complete
Thanks for submitting!
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