Pre-Opening Member Health Screening Questionnaire

Introduction

Here at Inspiring healthy lifestyles we value your health and in preparation for the reopening of our Leisure Centres we would like to understand if your health has changed since we closed our centres. Please do take the time to complete the questionnaire, we have a team of Specialist Instructors on hand to help our members to return to our centres safely

Step One: Personal Details

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* 1. Please provide your details as below:

Name:

Postcode:

Email Address:

Phone Number:

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* 2. Lifestyle card Number (if known):

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* 3. If you are completing the questionnaire on behalf of a member, please provide their details below

Name:

Postcode:

Email Address:

Phone Number:

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* 4. Lifestyle card Number (if known):

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* 5. Please tick to confirm that you grant permission for Inspiring healthy lifestyles to contact you by phone or by email to discuss your health or that of the person you are completing the questionnaire for. Please note that, should your health have materially changed since the 1st March 2020, access into the gym or fitness class sessions will be restricted until the discussions with our Specialist Instructors has taken place

Yes - I agree

No - I do not agree

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* 6. Which leisure centre do you normally attend?