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PHYSICAL ACTIVITY READINESS QUESTIONNAIRE 

Please complete the Physical Health Check & Consent Registration Form before booking any of our Studio or online classes.

To register for The Wellbeing Centre's activities please fill out the following medical form. Please note that the upstairs studio requires climbing some stairs and other classes are on the ground floor.

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had a chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem ( for example back, knee or hip) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Is there any possibility you may be pregnant?
Do you know of any other reason why you should not take part in physical activity?
We may need to contact you by text or email to advise of class changes, check bookings or advise of any additional classes/activities and share your information with your class instructor. Please choose to confirm how you would like to hear from us:
Would you like to subscribe to our newsletter, if not already? We do not share or sell your information with any other company for marketing purposes. Your information is used for this charity to provide a service to you and keep you updated on our activities and services that may be of inteest or value to you.
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