MCGOWAN MUAY THAI

Your Chosen Session

Monday
18:30 - 19:30

Basics
Adults

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£12.00 per session

27/01/2025

Personal Details

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Tick YES on the medical condition that applies to you By default, it is assumed that you do not have any medical conditions.	YES or NO
Have you ever suffered from heart trouble?	YES NO
Are you taking any form of medication?	YES NO
Do you suffer from chest pain?	YES NO
Do you suffer from dizzy spells?	YES NO
Have you ever had either high or low blood pressure, and or high cholesterol level?	YES NO
Have you ever had asthma, chronic bronchitis or any other chest ailments?	YES NO
Do you suffer from severe back pains or an orthopaedic problem?	YES NO
Do you suffer from severe headaches or migraines?	YES NO
Are you recuperating from a recent illness/operation or injury?	YES NO
Have you any medical condition that we should be aware of?	YES NO
Are you pregnant? If yes how many months?	YES NO
Is there any history of heart disease in your immediate family (before age 55)?	YES NO

Enter any other medical or disability

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