2 Week Trial just $10

PERSONAL DETAILS
All questions marked * below are mandatory, please fill them all out.
Name*
Phone*
Email*

MEDICAL DETAILS
All questions marked * below are mandatory, please fill them all out.
Has your doctor ever told you that you have high blood pressure or a heart condition, or have you ever suffered a stroke?*
- Yes
- No
As you answered YES to the question above, please provide more detail*
Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?*
- Yes
- No
As you answered YES to the question above, please provide more detail*
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
- Yes
- No
As you answered YES to the question above, please provide more detail*
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
- Yes
- No
As you answered YES to the question above, please provide more detail*
If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
- Yes
- No
As you answered YES to the question above, please provide more detail*
Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?*
- Yes
- No
As you answered YES to the question above, please provide more detail*
Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?*
- Yes
- No
As you answered YES to the question above, please provide more detail*
Do you have any allergies*
- Yes
- No
As you answered YES to the question above, please provide more detail
Do you or have you had cancer*
- Yes
- No
As you answered YES to the question above, please provide more detail
Have you recently undergone any surgery*
- Yes
- No
As you answered YES to the question above, please provide more detail

FINAL STEPS
All questions marked * below are mandatory, please fill them all out.
I believe that to the best of my knowledge, all of the information I have supplied within this form is correct.*
- Yes
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2 week trial

Step 1 of 3 - Personal Details

PERSONAL DETAILS

All questions marked * below are mandatory, please fill them all out.

MEDICAL DETAILS

All questions marked * below are mandatory, please fill them all out.

FINAL STEPS

All questions marked * below are mandatory, please fill them all out.

Mon - Thurs:	7am - 12pm / 4 - 7pm
Friday:	7am - 12pm
Saturday:	8 - 11am