PRE-EXERCISE QUESTIONNAIRE

Name *

E-Mail *

Phone Number *

How did you hear about VFH? Let us know who referred you so we can thank them! *

DOB *

Height

Weight

Gender *

Emergency Contact Name *

Emergency Contact Number *

Do you have a heart condition? *

Have you ever suffered a stroke? *

Do you ever feel unexplained sharp pains in your chest? *

Do you ever feel faint or suffer from dizziness? *

Do you suffer from Asthma? *

Do you have any muscle, bone or joint problems that could be made worse during physical activity? *

Do you smoke cigarettes daily? *

Do you drink alcohol daily? *

Have you been told you have high blood pressure? *

Have you been told you have high cholesterol? *

Do you have any other medical conditions that may make it dangerous for you to particpate in physical activity or require a medical clearance for you to partake in sessions at Velocity Fitness and Health PTY LTD? *

What are you interested in here at The Stomping Ground? *

Disclaimer: By completing this questionnaire you consent to being filmed, photographed and sound recorded while on VFH premises and this material being used for marketing or promotional purposes. We will ask your permission to include your name or social media handle. By joining Velocity Fitness and Health you are aware of this and give consent. If you do not wish for your image or sound to appear on social media, please email info@velocityfitnessandhealth.com