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One of our personal trainers will be in touch soon - in the meantime, please complete this health questionnaire

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Health Questions

Questions	Yes	No
Do you know of any reason you should not exercise or increase your physical activity?	Yes	No
Are you recovering from an illness, injury or operation?	Yes	No
Are you pregnant?	Yes	No
Are you 60 years or older and not used to being physically active?	Yes	No
Do you suffer from Asthma?	Yes	No
Has a Doctor said that you have a heart condition and you should only do physical activity recommended by a Doctor?	Yes	No
When you perform physical activity, do you feel a pain in your chest?	Yes	No
When not performing physical activity, have you recently suffered chest pain?	Yes	No
Do you ever lose consciousness or lose your balance due to dizziness?	Yes	No
Do you have bone or joint problems that may be made worse with physical activity?	Yes	No
Are you currently on any medication for blood pressure or a heart condition?	Yes	No
Do you have diabetes?	Yes	No
If you answered ‘YES’ to above, do you have insulin dependent diabetes?	Yes	No
Do you suffer from Atherosclerosis or Arteriosclerosis?	Yes	No
Do you suffer from Bronchitis?	Yes	No
Do you suffer from Epilepsy?	Yes	No
Do you suffer from Hepatitis?	Yes	No
Do you suffer from Hypertension?	Yes	No
Do you suffer from Hypotension?	Yes	No
Do you suffer from Meningitis?	Yes	No
Do you suffer from Multiple Sclerosis?	Yes	No
Do you suffer from Thyroid Problems?	Yes	No
Do you suffer from any ailment or injury that could affect your ability to perform physical activity?	Yes	No
Do you have any symptoms, or have you been diagnosed with Covid-19?	Yes	No
Have been in close contact with someone with coronavirus in the last 2 weeks?	Yes	No

If you have answered YES to one or more questions we may need you to contact your doctor before starting to exercise. If your health changes so that you may then answer YES to any of these questions, you must tell your trainer as soon as possible. Please tick if you agree to do so.

Click to read our terms and condtions

Covid risk assessment can be found here - pt2home.co.uk/covid

1. Purpose and Explanation of Fitness Assessments & Physical Activity

The selection of exercises and the intensity of the physical exercise will be deemed appropriate based on your health history and current level of fitness.

2. Risk and Discomforts

There are inherent risks associated with any form of physical activity. Training may result in acute muscle and/or joint pain, pulled muscles, brief changes in blood pressure, lightheadedness, dizziness, delayed onset muscle soreness (DOMS), more chronic conditions such as tendonitis, fast or slow irregular heart rhythm, abnormal blood pressure changes, lightheadedness, dizziness, fainting, chest pain, and other discomforts. Any type of physical activity may in rare instances lead to heart attack, stroke, or death, but this is unusual, especially in participants free of known coronary heart disease (CHD), free of any signs or symptoms of CHD, and with few major risk factors of CHD. Training should be modified or postponed if an injury is present or if pain or symptoms persist.

3. Cancellations

The client must provide the trainer with a minimum of 24 hours' notice if they wish to cancel/reschedule a session. Failure to do so will result in the session being taken and charged in full.

4. Inquiries

An important part of the informed consent process is providing you the opportunity to enquire about any aspect of the forthcoming fitness assessments and physical activity. If you have any questions or concerns whatsoever, please feel free to ask.

5. Use of Medical Records and Information

Any information gathered (such as health history information, signs or symptoms of disease, risk of disease, exercise risk, blood pressure, body composition, aerobic fitness, instances of joint pain, chest pain, lightheadedness or dizziness, etc.) will be kept confidential to the extent provided by law. Identifiable information will be handled as per our privacy policy which can be accessed via our website. You may be asked to allow certain information (from which your identity is removed) to be used for statistical analysis, research, or testimonial purposes.

6. Freedom of Consent

I agree to voluntarily participate in the fitness assessments and physical activity outlined & discussed. I understand that I am free to deny consent if I so desire now or at any point in the program.

7. Responsibilities of the Participant

It is important that you fully disclose your personal health history, any medications you are taking, and any symptoms you may be experiencing during exercise. Such symptoms would include joint pain, irregular heart rhythm, tightness or pressure in your chest, unusual shortness of breath, lightheadedness, dizziness, and the like. It is also important that you adhere to the recommendations of your instructor especially with regard to the choice and intensity of exercises you perform. You should not exceed the recommended exercise intensity (as measured by the weight lifted or exercise heart rate) and you should not exercise when you are injured, sick, or not otherwise feeling well.

8. Refunds

In order to be eligible for the 'results or your money-back guarantee, there must be 100% commitment to the workout programme, and nutritional guidance supplied must be followed; your diet will be monitored by use of a diet tracking app/food diary that you will update yourself. In the unlikely event of not receiving quantitative results different from baseline values obtained during the first week of a package, a refund of the package value will be given. Quantitative results typically include: weight loss/gain, an increase/decrease in body fat percentage, an increase in strength, or an overall increase in fitness. These are dependant on your goals set at the beginning of the package.

Please Read the Following Statements Carefully.

I acknowledge that I have read this form in its entirety or it has been read to me, and I understand my responsibility in future participation. I accept the risks, rules, and regulations set forth. Knowing these, and having had an opportunity to ask questions which have been answered to my satisfaction, I consent to participate in forthcoming fitness assessment & physical activity. If I am accidentally injured during fitness assessments or physical activity, your allocated personal trainer will offer immediate first aid (if needed) but will be unable to provide treatment. If injured, I will be responsible to seek treatment with my own physician or primary care provider. Furthermore, I, for myself and my heirs, fully release from liability and waive all legal claims against PT2Home Limited and its associates, including any personal trainers sub-contracted by PT2Home Limited, for injury, death, or damage that I might incur during participation.

Please tick if you have read, understand and agree to PT2Home Ltd terms & conditions

Client signature if everything is correct & agreed

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