Book now

Health SCreening Form

MY DECLARATION...

Please be as honest as possible as this questionnaire is used to gather information and helps to construct your plan and guide this journey.

MY DEtails...

People must not already be members of HealthFit.

My friends Details

People must not already be All we need is their name, email and mobile number. They cannot already be a HealthFit member.members of HealthFit.

My other friends Details

All we need is their name, email and mobile number. They cannot already be a HealthFit member.

My Goal...

Please state the main goal in mind, try to pick something that incorporates other goals. e.g. improving mental performance requires better sleep, hydration and fitness.

My Barriers...

Please be as honest as possible as this questionnaire is used to gather information and helps to construct your plan and guide this journey.

My Lifestyle...

1-2 being depressed/unhappy, 5-6 being melancholy, 9-10 feeling great!
1-2 very poor/dehydrated, 9-10 (90% clean diet & well hydrated)
1-2 restricted mover/low fitness, 9-10 being very fit/great mover.
1-2 being poor sleep, 9-10 being deep sleep
1-2 being very poor diet, 9-10 being very healthy diet and hydration levels
1-2 being low quality of life, 9-10 being high quality of life

My Medical History...

Common sense is your best guide in answering these few questions. Please read them carefully and check YES or NO to the question if it applies to you. If YES, please explain

If you answered YES to one or more of the previous questions...

If you have not already done so, consult with your doctor before increasing you physical activity and/or taking a fitness appraisal. Inform your doctor of the questions that you have answered YES to, or present this pre-activity readiness questionnaire copy. After medical evaluation, seek advice from your doctor as to your suitability for: (1) unrestricted physical activity starting off easily and progressing gradually, and (2) restricted or supervised activity to meet your specific needs, at least on initial basis.

If you answered NO to all questions...

If you answered the questions honestly and accurately, you have reasonable assurance of your present suitability for: (1) a graduated exercise programme
MM
DD
YYYY

Declaration

I declare that you, the fitness professional, conducting this challenge is not able to provide me with any medical advice with regard to any medical conditions that I may have, or indications of a disease that may occur in the future. The answers and results from both the health history and pre-activity forms are only used as a guideline with regard to my ability to exercise or whether I need to seek further medical advice. I will not hold this fitness professional liable of any future injuries or diseases that may occur in the future. I hereby state that I have read, understood and answered the questions above. I also state that I wish to participate in activities, which may include aerobic, resistance and flexibility exercises. I realise that my participation in these activities involve the risk of injury and even the possibility of death. I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Contact us

CALL US TODAY

Follow us

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form