HEALTH FORM

Thank you for providing the information that will support in providing you with the right type of service and guidance in your practice.

This list is a suggestion of the type of things that can affect how you are to practice.

Mention if you have had or have: 

Asthma, Cancer, Aids, Allergies, Depression, Diabetes, Fractures/broken bones, Glaucoma, Heart Disease, Hepatitits, High or Low Blood Pressure, High Choloresterol, Mental illnesses (yours or in the family), Bi-Polar, Stroke, Epilepsy, Arthritis/Rheumatism, Migranes/Headaches, Anemia, or anything else that is not mentioned in this list that is part of your medical present or history.

Do you smoke or are you an ex-smoker?

Are you on any medication?

Do you suffer from dizziness?

For women: How is your menstruation cycle? Are you in menopause? Any complications in your cycle?

Are you pregnant or trying to be? 

Do you have balance (physical balance) issues?

Do you lead a stressful life?

Are you undergoing any treatment at the moment?

Have you had any major operations/changes to your body?

If Yes to any of the above or other pertinent health / medical information that is relevant to you please provide further information for your safety during practice.

If any changes happen after filling this form please make sure to notify your instructor. Thank You.

The next of kin information is for if we need to contact someone in case of emergency while you are in our care.