Medical Questionnaire

Please fill out the form below before attending the gym. If you have answered yes to any of the questions below, you will still be able to use the facilities. We do however recommend seeking medical advice to avoid further illness or injury.

Has you doctor ever told you that you have a heart condition or have you ever suffered a stroke? *
Has you doctor ever told you that you have a heart condition or have you ever suffered a stroke? *
If you have diabetes (type 1 or 2) have you had trouble controlling your blood glucose in the last 3 months? *
If you have diabetes (type 1 or 2) have you had trouble controlling your blood glucose in the last 3 months? *
Have you been told that you have high blood pressure? *
Have you spent any time in hospital for any medical condition / illness / injury during the last 12 months? *
Are you pregnant or have you given birth within the last 12 months? *
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance? *
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months? *
Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise? *
Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise? *
Have you been told that you have high blood sugar? *
Have you been told that you have high cholesterol? *
Are you currently taking any prescribed medication(s) for any medical condition(s) not previously covered? *
I have answered these questions to the best of my ability and all of the information provided within this form is true and correct to the best of my knowledge. I also understand that any form of exercise by its nature carries with in some physical risk. I undertake training with Fierce Fitness UK Ltd with this knowledge and will not hold any person responsible for injury sustained whilst training *