Book – Medical Details Medical DetailsHiddenClientIdfr Do you have any medical considerations that we should be made aware of? Yes No Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? Yes No When you undertake moderate physical activity do you ever feel chest pain? Yes No Do you ever experience loss of balance due to dizziness or lose consciousness? Yes No Do you have a family history of? Heart or coronary heart disease Stroke Do you suffer from any of the following? Back pain/sciatica Lack of joint mobility or joint problems Osteoarthritis/ Arthritis Have you ever undertaken major surgery or surges of any kind? Yes No Have you broken or fractured any bones before? Yes No Do you ever experience shortness of breath with mild exertion? Yes No Are you currently taking any medication that we should be made aware of? Yes No Are you currently a regular smoker? Yes No Do you or have you in the past been a sufferer of asthma? Yes No Are you currently diabetic? Yes No Please give detailsAre you currently suffering from an under active or overactive thyroid? Yes No Are you or any of your immediate family epileptic? Yes No Are you currently pregnant or have you given birth in the last six weeks? Yes No Some of our programmes focus on progress relating to weight loss and or body fat ratios. If you feel this may be useful to you please record your height and weight here. Height (Metres) / Weight (Kg)Weight Height I have completed the following information accurately to the best of my knowledge. I understand that the programme I am taking part in has inherent risks of injury and holds a risk (however small) of serious injury or possible death. I realise that it is my responsibility to make staff aware of any medical conditions that I may have, and any medication I may need. I am also aware I must comply with staff instructions for my own safety. I will also disclose any discomfort I feel during exercise and inform staff if I need to discontinue. Staff reserve the right to refuse participation to clients that they believe to be in any way not fit to participate and in such circumstances no refunds will be given. I am aware of the risks, dangers and hazards associated with physical activity and freely accept and fully assume responsibility for such risks.