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Fitness Dynamics Health Questionnaire

Please complete this health questionnaire before attending your first class, course or session with Fitness Dynamics. It helps me understand any health conditions, injuries or other concerns that may affect your exercise, so I can support you safely and offer appropriate options or adaptations where needed.

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Your information will be treated confidentially and used only by Fitness Dynamics to help me support you safely during your classes and sessions.

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Please complete a new questionnaire if there are any significant changes to your health, medication or contact/emergency contact details, and at least once every 12 months. You’ll receive a reminder when your annual update is due.

Your Details:

Birthday
Day
Month
Year

Which classes or services are you interested in?

Which location(s) are you interested in?

Your Goals:

For example, posture, strength, flexibility, pelvic health, back pain, balance, confidence, sleep, stress, mobility, weight management, feeling fitter, meeting new people.

Health Screening:

Has a doctor ever told you that you have a heart condition, or advised you to only do exercise recommended by a doctor?
Do you ever feel pain in your chest during physical activity?
In the last month, have you had chest pain when not exercising?
Do you ever feel faint, dizzy, lose your balance, or lose consciousness?
Do you have any bone, joint, muscle, back, neck or mobility problems that could be made worse by exercise or movement?
Are you taking any medication that may affect your ability to exercise safely, such as blood pressure, heart conditions, diabetes, pain, dizziness, or balance medications?
Do you have any other medical condition, chronic illness, recent surgery, injury or physical limitation that may affect your participation in exercise or movement classes?
Have you had surgery in the last 12 months?
Are you pregnant, have you given birth in the last 12 months, or do you have any pregnancy or postnatal concerns I should be aware of?
Do you have any pelvic health symptoms or concerns?
Do you have any vision, hearing, or balance issues that may affect exercise safety?
Have you ever felt unwell, overheated, faint, or unusually breathless during exercise?
Is there any other reason why exercise may not be suitable for you at the moment?

Lifestyle & Activity:

For example, walking, gym, Pilates, yoga, strength training, or no regular exercise.

Additional Information:

IMPORTANT HEALTH NOTICE

If you answer YES to any of the health questions above, or if you have any concerns about exercising, please seek advice from your GP or an appropriate healthcare professional before taking part.

Participant Declaration:

Full name as your signature

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Date
Day
Month
Year

Stay Connected:

Would you like to receive class updates, timetables, wellness information, and Fitness Dynamics news by email?

Please add fitnessdynamics.co.uk to your safe sender's list to help prevent emails from going into your spam/junk folder.

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