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Health Waiver

Please complete the following medical form prior to your first session

Do you or have you had any of the following?:

Heart Problems or Chest Pains

High Blood Pressure

Respiritory Problems or Asthma

Diabetes

Epilepsy

Dizziness or Fainting

Arthritis

Other...

Are you currently on any medications?

No

Yes Please describe here:

I declare that the above information I have given is true and accurate to the best of my knowledge and that any injury, condition indicated has been cleared by a medical practitioner for the purpose of exercise. In the case of injury, condition arising after this date, I will notify 121 Personal Training in writing immediately. I hereby certify that I have voluntarily elected to participate in a Fitness Assessment and are aware of the content and procedure involved. I am aware that I am required to provide 24 hours notification of an appointment change or full fees will be applied.

Thanks for submitting!

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