BOOK TRIAL

Book Trial

Please complete the form below so we may confirm that you are a suitable candidate for this therapy. We will be in contact with you to arrange a time and payment before our first session. We look forward to make your health goals come true!

Cost of Trial Session: £19.99
(Cost of trial is reimbursed should you sign up for a membership)

Name(Required)
Address(Required)
I suffer from epilepsy or other neurological disorders:(Required)
I suffer from acute thrombosis or hypertension (heart disease)(Required)
I have a heart pacemaker, stents or had heart surgery in the last six months:(Required)
I suffer from any tumours or cancers:(Required)
I am or may be pregnant:(Required)
I had a recent operation:(Required)
I suffer from a bleeding disorder (haemophilia):(Required)
I suffer from abdominal or inguinal hernias:(Required)
I suffer from tuberculosis:(Required)
I suffer from a circulatory disorder (heart, blood vessels, lungs or other):(Required)
Consent(Required)
BY SELECTING THIS CHECKBOX AND SUBMITING THIS FORM, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE CONTENTS OF THIS INFORMED CONSENT, AND THAT I HAVE HAD ALL MY QUESTIONS ANSWERED TO MY SATISFACTION. I understand that my EMS Personal Trainer shall not be liable for any damages arising from personal injuries while and during an EMS personal training session. I assume full responsibility for any injuries or damages which may occur before, during, and/or after training. I hereby fully and forever absolve the EMS personal trainer, his/her assigns and agents from all claims, demands, damages, rights of action, present and future therein. I understand and have consented/ agreed that I am in good physical condition and that I have no disability, impairment or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety, comfort, or physical condition if I engage or participate (other than those items fully discussed on the Medical History Questionnaire). Any questions, which may have occurred, have been answered to my satisfaction.