BodyFix Screening Form

    Are you currently taking ANY medication? *

    Are you pregnant or have given birth in the last 3 months? *

    Is there a history of heart problems or chest pain in your family or with you? *

    If yes please detail below

    Do you have HIGH OR LOW blood pressure? *

    Do you have difficulty with physical exercise or advice from your GP to avoid specific movements? *

    If yes please detail below

    Do you have Diabetes? *

    Do you have any muscle, joint or back disorders that could be aggravated by physical exercise?*

    If yes please detail below

    Have you a recent surgery? (within last 3-6 months?) *