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HAPPY HEARTS

PRE EXERCISE INFORMATION

 

NAME

ADDRESS;

 

 

DOB

CONTACT DETAILS;

HOME;

MOBILE;

E-MAIL;

EMERGENCY CONTACT NAME & NUMBER;

 

GP DETAILS

NAME

PRACTICE ADDRESS;

TELEPHONE;

 

MEDICATION/REPEAT PRESCRIPTION, ONGOING REACURRING OR SEASONAL DISORDERS

(eg Cardiac, Pulmonary, Diabetes, Arthritis, SAD, joint or muscle problems, hip/knee replacements)

 

 

 

 

Please bring this form with you to your first class and arrive at least 20 minutes before the class commences. (pre booking essential)  

  Download  HERE   as a word doc or high light the above and print.

 

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