Appointment

Your Name *

Your Email *

Phone Number *

Husband/Father Name *

Address *

Date of Birth

Date of joining

Batch Time

How you know about us?

Have your physician advised you that you suffer from heart condition ?

Do You Feel Pain in your chest ?

Have you during the last year ?

Has your physician diagnosed asthma, and as a result in the last three months- ?

Has your physician told you in the last five years only to undertake physical activity under supervision

Do you suffer from any long-term/chronic condition, which is not mentioned above

For pregnant women: Has this, or any previous, pregnancy been diagnosed as high risk

Height

Weight

Chest

Hip

Arms

Thigh

Legs