Please fill out the pre-participation screening questionnaire before your session.  

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* 1. Full Name

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* 2. What is your occupation

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* 3. What is your gender?

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* 4. Date of birth

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* 5. Have you ever had a heart attack, coronary revascularisation surgery or a stroke?

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* 6. Have you ever been diagnosed with Deep Vein Thrombosis?

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* 7. Do you have a cardiac pacemaker?

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* 8. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?

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* 9. Do you suffer from any neurological diseases?

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* 10. Do you suffer from strong bleeding with abrasions or any history of a difficulty with blood clotting?

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* 11. Are you currently receiving treatment for cancer?

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* 12. Do you have any hernias or have you had hernia surgery?

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* 13. Are you pregnant? Note- You must notify us if you ever become pregnant as you are not allowed to do EMS if you're pregnant. 

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* 14. Do you have any injuries or medical conditions we should know about?

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* 15. Height (cm)

100 220
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 16. Weight (kg)

40 180
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 17. How did you find out about us?

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* 18. What is your goal for trying Bionic Fitness

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* 19. Emergency Contact

I declare that the information that I have supplied is accurate to the best of my knowledge and will be treated as confidential by all staff members of BIONIC FITNESS and as such will not be released or revealed to any other persons without a client’s written consent.

I recognise that exercise is not without some risk and known dangers, which commonly include sprains, strains, dizziness, fainting, discomfort in breathing, abnormal blood pressure, irregular heartbeats and in very rare instances heart attack.

I hereby understand, acknowledge and accept these risks and known dangers and certify that I have voluntarily elected myself to participate in a health and fitness evaluation and/or exercise program.  I agree to be bound to the terms and conditions as set out by BIONIC FITNESS.

I hereby release to the full extent permitted by law, the owner and staff of BIONIC FITNESS from all claims and demands of every kind with respect to any accident, damage, injury, loss to person and property, pain and suffering however caused.  This includes health and fitness assessments, personal training and personal exercise within BIONIC FITNESS facilities and any other form of exercise coordinated by BIONIC FITNESS, their staff, contractors, instructors or agents.  I wholly indemnify BIONIC FITNESS from and against all actions, suits, claims, costs, damages and expenses to which BIONIC FITNESS is or may be liable.
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