Physical Activity Readiness Questionnaire –

Please complete this health and safety questionnaire before participating in a fitness class or workout with me.  This is a legal requirement for me to be able to work safely and ensure that I understand your physical and mental health needs.

The more information you put on the form, the better able I am to support you.

  • Date Format: MM slash DD slash YYYY
  • Please fill in this form before exercising with me. I prefer to have 1:1 discussions first to make sure I accommodate for you, but it's not always possible.
  • Has your Doctor ever said you have a heart condition and that you should only do exercise recommended by a Doctor?
  • Do you feel pain in your chest when you do physical activity?
  • In the past month, have you had a chest pain when you were not doing physical activity?
  • Do you lose balance because of dizziness or do you ever lose consciousness?
  • Do you have a bone or joint problem (back, neck, knee or hip) that could be made worse by a change in physical activity?
  • Is your Doctor currently prescribing you medication for blood pressure or a heart condition?
  • Do you know of any other reason why you should not take part in physical activity?
  • Moving supports your body and mind

    You do not have to push yourself to the max in any of my classes.  Moving and getting the movement right is key.

  • Moving unlocks positive chemicals in your body

    Whether you understand science, biology or not, moving unlocks hormones, chemicals and neurotransmitters in your body that make you feel better.

    Endorphins, dopamine, serotonin.

    Endorphins are likened to morphine, dopamine is associated with positive experiences, serotonin is prescribed to people who struggle with low mood.

    If you can encourage these naturally occurring chemicals within your body from exercise, why would you not!?

  • Moving Focusses on You

    You may think that attending a class is some sort of competition. To some it is, but my drive really is to promote you to think about what your body is doing and that you are only ‘competing’ against yourself.  For some, exercise is the only ‘free’ time given in a day to just your thinking, your space.

    It is incredibly important to created this time, whether it’s yoga, circuits, or a walk.  Creating a time to move and just think about your needs is really good for your mental health, although there are challenges that come with this too.