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Covid-19 Health Declaration

How are you feeling today?

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Covid 19 Health Declaration

Health Questionnaire

Please fill out the following form BEFORE YOUR FIRST VISIT to help us understand your physical condition.

If you answer YES to one or more questions -

A member of the centre will ask you further questions relating to your answers below and will advise you on how to proceed.

Prior to an induction appointment being made Fuller Life's team members may request that you consult with your doctor before using our facilities.  Your doctor will advise you as to your suitability for further physical exercise.

This questionnaire does not in any way represent a medical examination.

You are only required to complete this form once -  before your first visit to Fuller Life Health & Fitness Centre.  Please complete the Covid-19 Health Declaration before EACH visit

Have you been advised by your doctor that you have a heart condition and/or been recommended only medically supervised exercise?
Do you feel pain in your chest when doing physical activity?
Do you suffer from epilepsy?
Has your doctor/nurse ever said that your blood pressure was too high?
Has your doctor ever told you that you have bone or joint problems that may be worse with exercise?
Do you ever lose consciousness or lose control of your balance due to exercise?
Are you pregnant or have you given birth within the last 3 months?
Is there any other reason, not stated above, that exercise or physical activity may not be suitable for you?

Declaration:

I have read and fully understand this questionnaire and confirm that, to the best of my knowledge, the answers given by me are correct and accurate.  I know of no reason why I should not participate in any form of physical exercise or any such activity suggested to me by any employee or representative of Fuller Life. Health & Fitness.  I acknowledge that any suggestions from any such employee or representative regarding exercise, healthcare and nutrition are neither diagnostic nor prescriptive.

I agree to notify a fitness instructor of any future changes to the above answers before continuing to exercise.

 

It is strongly recommended that I do not use any item of exercise equipment that I am unfamiliar until I have appropriate guidance from a fitness professional.  In the absence of a qualified fitness professional I may use the facility but at my own risk.

 

Important:

Fuller Life Health & Fitness may use the information you have provided in this questionnaire and any other information provided by you relating to your mental and physical condition to ascertain whether physical exercise is appropriate for you and, if necessary, to seek further information from your doctor or other specialist.  By accepting and submitting this declaration, you agree to the use of your information as stated in this Data Protection Statement.

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Health Q
Induction Waiver Form

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Induction Waiver
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