Gym Members - Self Declaration for non-cardiac patients
Please read the following questions carefully and answer as honestly as possible.
Do you have, or have you ever had any of the following?
Frequent or severe headaches
Dizziness or fainting spells
Asthma or lung disease
Heart or vascular problems
High or Low blood pressure
Epilepsy or seizures
Muscular disorders or complaint
Lower limb or joint problems
Has your doctor ever advised you not to partake in exercise?
(Women only) Are you or have you been pregnant in the past year
If you have answered yes to any of the questions above you are strongly recommended to seek medical advice before using gym facilities.
Emergency Contact Details
I declare that I am not aware of any medical reason why I should not use the exercise facilities at this Centre.
I understand that I use the facilities at my own risk and that I agree to adhere to the centre's rules and etiquette and use the equipment in the manner I have been shown in order to prevent injury to myself or others and damage to the equipment.