Forest Mere Health Club Membership - Champneys

Personal Health Questionnaire
Tick all that apply to you/and your partner joining:
You Partner
c c High Blood Pressure
c c High Cholesterol Level
(6.5 mmol or higher)
c c Heart Condition
c c Diabetes
c c Arthritis
c c Back/Neck Problem
c c Shoulder Problem
You Partner
c c Medication
c c Varicose Veins
c c Thyroid Problem
c c Recent Illness
c c Recent Surgery
c c Cigarette Smoker
c c Other
Explain:
1. Do you exercise regularly You Yes c No c Partner Yes c No c
If Yes, please specify:
2. Do you have regular spa treatments e.g. massage
You Yes c No c Partner Yes c No c
3. What activities do you plan to participate in at The Club
In case of an emergency notify Name/Tel:
Book your complimentary Health Appraisal and Gym Introduction on joining.
To make sure that your time and effort is spent effectively in the gymnasium, you will benefit from knowing
your current level of fitness. Our fully qualified instructors can give you vital information regarding your health
and fitness by measuring and evaluating:
c Blood Pressure c Resting Heart Rate c % Body Fat c Cardiovascular Fitness
Our instructor will ask you questions about your lifestyle and current level of physical activity in order to gain
an overall picture of your current state of health. You will have the opportunity to discuss your personal
fitness goals and the specific areas that need attention.
Re-Assessments
What has happened to all that hard work, time and effort At the end of 3 months, book yourself a
re-assessment and see the difference!
Body Composition Analysis
When following a diet or exercise programme, it is important to ensure that body fat is lost rather than lean
tissue. Through a quick, simple test we can determine your percentage of body fat, lean tissue, basal
metabolic rate and identify your training needs. To book your Health Appraisal, Re-assessment, Body
Composition Analysis or other wellbeing and fitness services contact the Fitness Desk or the Health
Club Administrator.