Health Questionnaire

Booking Form

Health questionnaire:

Please fill in our health questionnaire

Name*

Date of Birth*

Email*

Your Telephone Number*

Next of Kin*

Next of Kin Telephone Number*

Are you vegetarian?*

Do you eat fish?*

Are you vegan?*

Are you gluten intolerant?*

Are you wheat intolerant?*

Are you lactose intolerant?*

Do you have a nut allergy?*

Do you have any other allergies?*

Is there any other information you should tell FitFarms?

What is your current weight?

What is your height?

Do you have any chest pains?*

Do you have any joint problems?*

Have you fainted in the last 2 years?*

Do you have high blood pressure?*

Do you take medication? If so, please state them below:

Are you pregnant?*

Have you had any operations? If so, please state them below: