Health Screening Form

This form is strictly confidential. The information you provide helps Andy tailor your programme safely and effectively.

Personal Details

Medical Conditions

Tick all that apply

Health Questions

Please answer all questions

Have you ever been told by a doctor that you have a heart problem or experienced chest pains during exercise?

Is there a family history of coronary heart disease in a first-degree relative under the age of 55?

Have you had any operations or medical procedures in the last 6 months?

Are you currently taking any prescribed medication?

Have you had any recent serious illness or been hospitalised in the last 12 months?

Do you have any injuries, joint problems, or physical limitations that may affect your ability to exercise?

Do you currently smoke or vape?

Do you currently exercise regularly (2+ times per week)?

Are you pregnant or have you given birth in the last 6 months?

Additional Information

Your information is kept strictly confidential and used only by Andy for coaching purposes.