Book a Drop-in - Drakes Gym

Lifting with Pearce - 03/06/2026 12:00

Full Name

Email address

Phone number

Date of birth

Gender

Country

How did you hear about us?

Address

Medical/Injury Details

Emergency contact

Full name

Phone number

Legal Documents

Omni-Health and Fitness Ltd - Physical Activity Readiness Questionnaire (PAR-Q)

Please read the following questions carefully and answer honestly. If you answer 'Yes' to any, you may be required to provide medical clearance before participating in physical activity.

Scroll to view entire agreement

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

Yes

Do you feel pain in your chest when you do physical activity?

Yes

Have you ever lost balance, felt dizzy, or lost consciousness during exercise?

Yes

Do you have a bone, joint, or other health problem that could be made worse by physical activity?

Yes

Are you currently taking prescribed medication for a heart condition or blood pressure?

Yes

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

Yes

If you answered 'Yes' to any question, please provide details below.

I confirm that the information I have provided is accurate and complete to the best of my knowledge. I understand that if I have answered 'Yes' to any question, I may need medical clearance before participating in physical activity.