Name *
Name
Have you ever suffered from a heart condition? *
Do you currently or have you ever suffered from chest pains?
Have you ever had asthma, chronic bronchitis or any other chest ailments?
Is there any history of heart disease in your family? (under the age of 55) *
Do you ever suffer from dizziness or feel faint? *
Have you ever had high or low blood pressure and/or high cholesterol? *
Are you presently taking any form of medication? *
Do you suffer from back pains or any other bone or joint problems (such as bad knees)? *
Do you suffer from severe headaches or migraines? *
Are you recuperating from a recent illness, injury or operation? *
Have you any medical condition I should be aware of? (e.g diabetes, asthma, epilepsy) *
Are you pregnant or have you given birth in the last 6 months? *
Signature *
Signature
I confirm that I have read, fully understood and answered the questions honestly.
PLEASE TICK THE BOX TO SUBSCRIBE TO THE ENJOY TRAINING NEWSLETTER FOR UPDATES ON CLASSES, WORKSHOPS AND EVENTS

Data Protection Statement 2019 Your personal confidential information in this form and consultation notes are stored securely. Your data is not entered into a digital database of any kind. I do not use it for any other purpose other than our consultations and it is not shared with anyone else without your consent. You have the right to request secure disposal of your notes and file at any time.