Health Questionnaire

How did you hear about us (tick which one applies)

Local Facebook groupsJH Fitness Facebook PageJH Fitness InstagramWord of MouthGoogleFlyer/LeafletOther

Many health benefits are associated with regular exercise. For most people, physical activity should not pose any problem or hazard. There are a certain amount of benefits and risks associated with any type of physical activity. The PAR-Q is a simple self-screening tool that is designed to help uncover any potential health risks associated with exercise.

1. Do you now or have you ever suffered from epilepsy/photosensitive epilepsy?
YesNo

2. Are you pregnant?
YesNo

If yes, how many months

3. Have you given birth in the last 16 weeks?
YesNo

4. Have you ever suffered from heart trouble/a heart condition and that you should only do physical activity recommended by a doctor?
YesNo

5. Are you presently taking any form of medication?
YesNo

* If yes please comment here

6. Do you suffer from chest pains? (either when you are undertaking physical activity or not)
YesNo

7. Do you ever have spells of dizziness or feel faint and lose balance or consciousness because of this?
YesNo

8. Have you ever had either high or low blood pressure, and/or high cholesterol?
YesNo

9. Have you ever had asthma, chronic bronchitis or any other chest ailments? If you have asthma are you currently using an inhaler and do you have it on your person?
YesNo

10. Do you have bone, joint or muscle problems (for example, back, knee, or hip) that could be made worse by a change in your physical activity?
YesNo

11. Do you suffer from severe headaches or migraines?
YesNo

12. Are you recovering from a recent illness/operation or injury?
YesNo

13. Have you any other medical conditions that we should be aware of?
YesNo

14. Is there any history of heart disease in your immediate family (before age 55)?
YesNo

15. Do you currently have any of the main COVID-19 symptoms?
YesNo

16. Have you tested positive for COVID-19 in the last 7 days?
YesNo

Please comment in the box below with any health issues/conditions you have or any injuries old or new, or if you have answered yes to any of the above questions.

PLEASE NOTE: If any of the above answers change at any time, please inform a member of JH Fitness before taking in part in any exercise. Should you fail to do so, JH Fitness cannot be held liable or responsible for an injury or any associated issues.

I consent to receive:
Class updates (including but not limited to immediate class changes, cancellations, updates regarding the timetable, price changes, etc) YesNo
Generic updates (including but not limited to generic newsletters, generic updates, etc) YesNo
Marketing emails (including but not limited to promotions, offers, etc). YesNo

I confirm I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury. I agree that if I engage in a class or use any equipment in any class, I do so entirely at my own risk. I agree that I am voluntarily participating in these classes and that I have obtained medical clearance to attend any classes and/or use any equipment involved.

Enter your full name here to confirm the above:

If you do not want us to use your data you may advise that you wish to withhold your consent when providing the information or you may do so by sending us an email to info@jhfitness.co.uk at any time. Please refer to the privacy policy for more information.