PYSICAL ACTIVITY READINESS QUESTIONNAIR

PLEASE FILL IN THE FOLLOWING FORM TO HELP US UNDERSTAND YOUR HEALTH CONDITION.

First Name

Email Address

Last Name

Date of Birth

Have you been hospitalized in the last 12 months?

No

Yes

Are you currently suffering from a medical condition, illness, or injury?

No

Yes

If you answered yes to any question, please elaborate

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

JACKOS GYM

COLLOP GATE FARM

MANCHESTER ROAD

OL10 2PX

PRIVACY POLICY

COOKIE POLICY

REFUND POLICY

LIABILITY WAIVER

COVID-19 INFORMATION

WE LOOK FORWARD TO SEEING YOU SOON

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

SUNDAY

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6AM -4:00PM

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