Health Waiver

Has your doctor ever said that you have a heart condition and recommended only medically approved physical activity?
Do you have chest pain brought on by physical activity?
Have you developed chest pain at rest in the past month?
Do you lose consciousness, or lose your balance as a result of dizziness?
Do you have a bone or joint problem that could be aggravated by the proposed physical activity?
Are you currently on any form of medication (e.g. tablets, inhaler)?
Are you pregnant, or have you been pregnant in the past three months?
Are you aware, through your own experience or a doctor’s advice, of any other reason for not exercising without medical approval?

Everyday Fitness Gym and Studios
1 High street, Wroughton, SN4 9JX 
Swindon, UK

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