Storm Fitness New Starter Form

Email Address

Name

D.O.B.

Address

Postcode

Contact Telephone Number

How did you hear about Storm FItness? How did you hear about Storm FItness? Google Social Media A Recommendation Other

Other

GP Name/Practice

Emergency Contact Name

Has your doctor ever said that you have a heart condition and that you should only do activity recommended by a doctor? Has your doctor ever said that you have a heart condition and that you should only do activity recommended by a doctor? Yes No

Do you feel pain in your chest when you do physical activity? Do you feel pain in your chest when you do physical activity? Yes No

In the past month have you experienced chest pain when you were not doing physical activity? In the past month have you experienced chest pain when you were not doing physical activity? Yes No

Do you lose balance because of dizziness or do you ever lose consciousness? Do you lose balance because of dizziness or do you ever lose consciousness? Yes No

Do you have a bone or joint problem that could be made worse by a change in your physical activity? Do you have a bone or joint problem that could be made worse by a change in your physical activity? Yes No

Is your doctor currently prescribing any drugs?

Please personalise your preference with regards to photography and videography- Our trainers regularly use photography and video to measure progress, better explain exercises and occasionally for marketing purposes. Please tick the boxes below to select under which circumstances you are happy for photo and video to be used.Please note you can update your preferences at any time by emailing us info@storm-fitness.com Please personalise your preference with regards to photography and videography- Our trainers regularly use photography and video to measure progress, better explain exercises and occasionally for marketing purposes. Please tick the boxes below to select under which circumstances you are happy for photo and video to be used.Please note you can update your preferences at any time by emailing us info@storm-fitness.com Photographs for internal use to measure progress and or technique Video for internal use to measure progress and or technique Photography to be used on our website Video to be used on our website Photography to be used on our social media and the social media of our trainers Video to be used on our social media and the social media of our trainers

Do you know of any other reason why you shouldn't do physical activity?

I have read and understood the terms and conditions and cancellations policy available here I have read and understood the terms and conditions and cancellations policy available here Yes I have read the terms and conditions and I am happy to proceed