Book a Drop-in - Total Workout

Perform - 25/09/2026 18:00

Full Name

Email address

Phone number

Date of birth

Gender

Address Line 1

Address Line 2

City

Region

Postcode

Country

Full name

Phone number

Medical history for each individual client

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Has your doctor ever said you have a heart condition and/or high blood pressure?

Yes

Do you feel pain in your chest when at rest, during any daily activities or during physical activity?

Yes

Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?

Yes

Are you currently taking prescribed medications for a chronic medical condition? PLEASE LIST CONDITION(S) AND MEDICATIONS HERE: (n/a if no)

Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem?

Yes

Has your doctor ever said that you should only do medically supervised physical activity?

Yes

I hereby confirm the information provided is accurate and complete