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consistency is key
Fitness Classess
Box & Lift
24 HOUR GYM MEMBERSHIP
Hackney 24 Hours Gym Membership
Islington 24 Hours Gym Membership
Membership Discounts
Personal Training
Massage
Sports Rehabilitation
Office Massage
Massage Therapy
Massage Drop in Sessions
Hire Gym
Personal Trainer Hire
Events Hire
Kids 2 Elite
eE in the Community
Charity Outreach
Wellbeing at Work
Wellbeing in the Community
Name
*
First Name
Last Name
Email
*
To your knowledge, do you have highblood pressure ?
Yes
No
To your knowledge, do you have low blood pressure?
Yes
No
Do you have Diabetes mellitusorany other metabolicdisorder?
Yes
No
Has your doctor ever said that you have raised cholesterol ( serum level above 6.2mmol/ L ) ?
Yes
No
Do you or have you ever suffered a heart condition?
Yes
No
Have you ever felt pain in your chest when you do physical exercise?
Yes
No
Is your doctor currently prescribe you drugs or medication?
Yes
No
Have you ever suffered from shortness of breath at rest or with mild exercise?
Yes
No
Is there any history of Coronary Heart Disease with in your family?
Yes
No
Do you ever feel feint, have spells of dizziness or have ever lost consciousness?
Yes
No
Do you know of any other reason why you should not participate in a programme of physical activity?
Yes
No
If you answered YES to one or more questions: If you have not already consulted with your doctor by telephone or in person before increasing your physical activities and / or taking a fitness appraisal. Inform your doctor of the questions that you answered YES to in the PARQ. Or present the PARQ copy to your doctor. After medical evaluation, seek advice from your doctor as to your suitability for 1. Unrestricted physical activity starting off easily and progressing gradually. 2. Restricted or supervised activity to meet your specific needs at least on an initial basis. If you answered NO to all the questions in the PARQ honestly and accurately , you have reasonable assurance of your present suitability for personal training session as well as exercise and fitness classes. This also includes any fitness programs that have been prescribed to you by a trained professional.
Assumption of Risk I here by state that I have read, understood and answered honestly the questions above . I also state that I wish to participate in activities , which may include aerobic exercise , resistance exercise and stretching .I realise that my participation in these activities involves the risk of injuries 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.
yes
no
Thank you!
