Step 3: Medical Restrictions

Please let us know of any medical issues which will restrict your training.

Thank You For Submitting Medical Restrictions


Please now proceed to Step 4



Emergency Contact Full Name



Emergency Contact Phone



Relationship to you





Are you currently a smoker?

NO    

YES   

Have you ever been diagnosed High Blood Pressure?

NO    

YES   

Do you have diabetes?

NO    

YES   

Do you have high cholesterol?

NO    

YES   

Do you suffer from (have you suffered from) recurring dizziness?

NO    

YES   

Do you suffer from (have you suffered from) epilepsy?

NO    

YES   

Do you have (or have you had) rheumatic fever?

NO    

YES   

Do you have (or have you had) stomach problems?

NO    

YES   

Do you have (or have you had) liver/kidney disease?

NO    

YES   

Do you suffer from (have you suffered from) chest pains?

NO    

YES   

Do you have (or have you had) a heart murmur?

NO    

YES   

Do you have (or have you had) a heart condition?

NO    

YES   

Have you ever had a stroke/TIA?

NO    

YES   

Do you have (or have you had) glandular fever?

NO    

YES   

Do you have (or have you had) any infectious diseases?

NO    

YES   

Do you have (or have you had) any other chronic illnesses?

NO    

YES   

Do you have (or have you had) a hernia?

NO    

YES   

Do you suffer from arthritis?

NO    

YES   

Do you suffer from hip/knee/ankle problems?

NO    

YES   

Do you suffer from shoulder/elbow/wrist problems?

NO    

YES   

Do you suffer from back problems?

NO    

YES   

Have you been hospitalised recently?

NO    

YES   

Are you pregnant or have you give birth in the past few months?

NO    

YES   

Are you on any prescription medications?

NO    

YES   

Are you suffering from anxiety/depression?

NO    

YES   



Please provide below, any further information or details relevant to any health or medical condition that have answered 'Yes' to or others not already been addressed & indicate your current state of fitness (last 2 months):





I understand that Fit For Life is not able to provide me with medical advice with regard to my medical fitness; this information is used as a guideline to the limitations of my ability to exercise. I will not hold Fit For Life liable in any way for injuries that occur while participating in this program.



Thank You!
PROCEED TO FINAL STEP