Health Form

Please fill out this Health Questionnaire if you're joining us for the first time, and please read the 'Important' notes below before submitting!

Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?
Do you frequently have pains in your chest when you perform physical activity?
Have you had chest pain when you were not doing physical activity?
Have you had a stroke?
Do you lose your balance due to dizziness or do you ever lose consciousness?
Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program (i.e., diabetes, osteoporosis, high blood pressure,
Are you pregnant now or have given birth within the last 6 months?
Do you have asthma or exercise induced asthma?
Do you have low blood sugar levels (hypoglycemia)?
Do you have diabetes?
Have you had a recent surgery?
Do you take any medications, either prescription or non-prescription, on a regular basis?

Thanks for your feedback!

Important:

Please note: If your health changes such that you could then answer YES to any of the above questions, tell your trainer/coach.

Ask whether you should change your physical activity plan.

By submitting the form above you are confirming that you have read, understood, and completed the questionnaire. Any questions you had were answered to your full satisfaction.

By submitting the form you also agree to the following:

1. I understand that Alborz Fitness sessions may occasionally take place outdoors, possibly on uneven ground and/or with limited lighting. I acknowledge and accept the potential dangers that my participation in sessions, in such conditions, may involve.

2. I confirm that I will inform the Trainer at the beginning of each session of any medical or other condition(s) that I may have that may affect my participation in that session. I acknowledge that whilst Alborz Fitness will take note of such condition(s) and advise of necessary alternatives to the session, I will proceed with the session at my own risk and am fully responsible for protecting my own health and safety in relation to any conditions I have. If I require medication such as an inhaler, it is my responsibility to bring these along to sessions. I agree to inform the Trainer of any conditions, and where necessary, provide written consent from my medical practitioner, before continuing with physical activity.

3. I agree to abide by all oral notices regarding safety and technique given during an Alborz Fitness session. I am aware that I have the opportunity to ask questions about the activities, use of equipment and other related issues during a session. If I choose to disregard any advice given, I do so at my own risk and accept liability for all resulting injuries or damage.

4. I understand that Alborz Fitness is not responsible or liable for any injuries or damage resulting from my participation in the session unless where Alborz Fitness has been negligent or failed to take reasonable care.

5. Those with medical conditions only: I can confirm that I have had approval from my GP to commence suitable exercise. Whilst I am aware that every effort has been taken to ensure that Alborz Fitness exercise classes are suitable for those with medical conditions, I understand that my participation and safety is my responsibility.