Gym Membership £30.00 1 Membership Form2 Medical Questionnaire Title*TitleMsMissMrsMrName* First Name Surname Address* Address Line 1 Address Line 2 City County Postcode Email Address* Phone Number*Name of Next of Kin* First Last Next of Kin Phone Number*Date of Birth* DD MM YYYY Please select the appropriate option*MaleFemaleMembership Start Date* DD MM YYYY Please Tick As Appropriate Do you have any heart or circulatory disorders? Is your mobility restricted in any way? Do you have any back problems or have had any operations? Are you taking any prescription medication? Are you currently pregnant or within 6 weeks of birth? Have you been diagnosed as having Cancer or are under going sessions of Chemotherapy or Radiotherapy? Do you have any metal plates or pins or have a pacemaker? Do you have any systemic disorders e.g. epilepsy, kidney problems etc. Do you feel pain in the chest either during physical activity or immediately afterwards? If you have any of the above medical conditions you are advised to contact your GP prior to arrival.Do you have any medical conditions or physical disorders not listed above?YesNoIf yes please give detailsAgreement*Please tick this box to confirm that you agree to the following: Physfit Gyms do not accept any responsibility for any injuries following the incorrect use of equipment. The information I have provided is true and complete to the best of my knowledge. I agree* Continue to payment Category: Uncategorized Post navigation
Gym Membership £30.00 1 Membership Form2 Medical Questionnaire Title*TitleMsMissMrsMrName* First Name Surname Address* Address Line 1 Address Line 2 City County Postcode Email Address* Phone Number*Name of Next of Kin* First Last Next of Kin Phone Number*Date of Birth* DD MM YYYY Please select the appropriate option*MaleFemaleMembership Start Date* DD MM YYYY Please Tick As Appropriate Do you have any heart or circulatory disorders? Is your mobility restricted in any way? Do you have any back problems or have had any operations? Are you taking any prescription medication? Are you currently pregnant or within 6 weeks of birth? Have you been diagnosed as having Cancer or are under going sessions of Chemotherapy or Radiotherapy? Do you have any metal plates or pins or have a pacemaker? Do you have any systemic disorders e.g. epilepsy, kidney problems etc. Do you feel pain in the chest either during physical activity or immediately afterwards? If you have any of the above medical conditions you are advised to contact your GP prior to arrival.Do you have any medical conditions or physical disorders not listed above?YesNoIf yes please give detailsAgreement*Please tick this box to confirm that you agree to the following: Physfit Gyms do not accept any responsibility for any injuries following the incorrect use of equipment. The information I have provided is true and complete to the best of my knowledge. I agree* Continue to payment Category: Uncategorized
