Low Back Pain Workshop Health Questionnaire
PLEASE MAKE SURE YOU HAVE ALSO SUBMITTED THE MAIN HEALTH QUESTIONNAIRE
- CLICK HERE to complete the MAIN HEALTH QUESTIONNAIRE or go to the bottom of this page to complete the LOW BACK PAIN HEALTH QUESTIONNAIRE
All classes are led by a Chartered Physiotherapist who is trained in exercise rehabilitation and Pilates.
All exercises will begin at a beginners level and will advance depending on your ability and fitness level.
It is important that you exercise to you own ability and comfort.
I understand that at any time I feel pain, fatigue, discomfort or light-headiness during the session, I will immediately stop the exercise and inform my teacher.
Whilst every care will be taken, there does exist the possibility of certain dangers when exercising and it is impossible to predict the exact response to exercise. Every effort will be made to minimise risk by evaluation of the health information you give in this questionnaire and by observation during exercising.
I understand that it is my responsibility to follow the teacher's instructions in order to exercise safely. I will listen to my body and rest when needed.
Please Let the teacher know if you feel unwell at any point within class.
No Liability can be accepted if:
- You fail to observe instructions on safety of exercise.
- Injury is caused by negligence of another class participant.
- Your doctor/midwife has advised you against exercise on health grounds.
I have answered these questions to the best of my belief and will update the teacher of any changes in my health or if I become pregnant.
I understand that my failure to do so, may post a threat to my health and or physical well being and I hold Sussex Physio Pilates and my teacher, from any liability whatsoever, arising from failure on my part.
By my electronic submission below, I agree to this policy and client agreement.
THIS INFORMATION IS PROTECTED BY THE DATA PROTECTION ACT 1998