healthquestionnaireform

Home
ELITE SCHOOL OF DANCE
ADULT DANCE AND FITNESS CLASSES
- Adult Timetable
1-2-1 STRENGTH COACHING
News
Contact
Our T&C's
branded clothing

Elite Studios Health Questionnaire

* Indicates required field

Name *

First

Last

Address *

Email *

Mobile Contact Number *

Date Of Birth *

Emergency Contact *

Additional Information *

Anything we should know?

Medical History *

Diabetes Heart Problems High / Low Blood Pressure Stroke Asthma Chest pain Arthritis Epilepsy Osteoporosis High Cholesterol NONE OF THE ABOVE

Do you smoke? *

Are you or could you be pregnant? *

Do you take any pills, tablets, medicine or medication? *

Is there anything else that may affect you exercising? *

Declaration If having ticked any boxes within the history section, I can confirm that I have consulted a doctor and that I have clearance to participate in fitness classes at Elite Studios. *

Please insert full name and date completed

Submit

Elite Studios | Elite School of Dance
Elite Dance and Fitness Studios Ltd (Trading as Elite Studios)
Company Registration Number: 09601557

Proudly powered by Weebly

Home
ELITE SCHOOL OF DANCE
ADULT DANCE AND FITNESS CLASSES
- Adult Timetable
1-2-1 STRENGTH COACHING
News
Contact
Our T&C's
branded clothing