Medical Declaration Form2017-04-03T16:35:38+00:00

ZOE HODGSON PILATES MEDICAL DECLARATION

Please read the following questions carefully and answer as honestly as possible.

DO YOU HAVE, OR HAVE YOU EVER HAD ANY OF THE FOLLOWING: (please tick all that apply)

Frequent or severe headachesDizziness or fainting spellsEpilepsy or seizuresAsthma or lung diseaseHeart or circulatory conditionsChest painsHigh or Low blood pressureStrokeDiabetesMuscular disorder or complaintBack or Neck problemsJoint problemsOsteoporosis or related fracturesAre you or have you been pregnant in the past yearAny other medical conditions that may affect exercise participationHas your doctor ever advised you not to partake in exercise

I declare that the details I have given are true to the best of my knowledge and that I am not aware of any reason why I should not use any of the facilities at Zoe Hodgson’s Pilates Studio.

I understand that it is my responsibility to notify my instructor of any special needs, concerns about participation or changes to my health. I use the facilities at my own risk and I agree to adhere to the studio rules and etiquette and use the equipment in the manner I have been shown in order to prevent injury to myself or others and damage to the equipment.

I will inform you via email info@zoehodgsonpilates.co.uk of any changes to my health.

I accept the studio Terms & Conditions.