Health Screen Form

Health Screen Form

If you need to collect your clients medical, lifestyle or even personal information this form is for you, use this well detailed form template to collect all information by embedding the form to your website or by emailing the clients directly. Form Preview
  • Part 1. Contact Details

  •  -
  • Part 2. Personal Measurements

  • Part 3. Occupation & Lifestyle

  • Part 4. Medical History

  •    
  • Part 6. Your Nutrition Habbits

  • Please Read The Following T&C's.

  • 1.) CANCELLATIONS

    Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

    2.) LATE ARRIVALS

    Each session shall be 45min in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

    3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

    All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

  •    
  • Should be Empty: