Join our mailing list
The Pilates Studio Kent logo
 
 
 
 
 
 


Health Questionnaire

Name:

 

Address:




Postcode:

Phone Nos:

Email:

Occupation:

Age/DOB:

How did you find The Pilates Studio Kent?
If not listed please state how here

Medical Questionnaire

 
1. Are you 45 years old or older?
   
2. Have you been inactive for the past 12 months?
   
3. Has a blood relative has suffered heart disease?
   
4. Do you have elevated cholesterol levels?
   
5. Are you a Type II diabetic?  
   
6. Do you have high blood pressure?  
   
7. Are you dieting or fasting?  
   
8. Have you ever experienced chest pains when exercising?  
   
9. Have you ever experienced chest pains when NOT exercising?
   
10. Do you feel dizzy / lose your balance / ever lost conciousness?
   
11. Do you suffer from any joint problems?
   
12. Do you take prescribed drugs for health reasons?
   

       

Tel 01622 763965

   

© 2010 The Goddess Star Monroe Group Trading as The Pilates Studio (Kent)
197 Boxley Road, Maidstone, Kent ME14 2TL
All rights reserved.

 
Site designed by Captivewebs.com