New student health & fitness evaluation

This form must be completed prior to your first class

Some things to note for your first Studio Torus class -

  • Arrive 5 minutes early to familiarise yourself with the space, find your mat and relax before class starts

  • Bring a water bottle

  • Wear comfortable exercise clothes, we don’t wear shoes in yoga or pilates, however we do for HIIT and running

  • Help yourself to a cup of tea on arrival

  • Feel free to get an extra piece of equipment for your comfort, such as a bolster or blanket in yoga.

  • Make sure you listen to your body and go at your own pace, ask questions to your instructor

Date *
Date
Name *
Name
Phone *
Phone
Emergency contact information *
Emergency contact information
Phone *
Phone
Date of birth *
Date of birth
Were you referred/recommended to exercise by your doctor?
Are you currently pregnant
MEDICAL PROFILE
Are you a male over 35 or female over 45 and NOT used to regular exercise? *
Has your Dr ever told you, you have heart trouble? *
Do you have a family history of cardiovascular disease/ heart trouble? *
Do you ever suffer from pains in the chest? *
Do you often feel faint or have dizzy spells? *
Has your Dr ever told you, you have high blood pressure?
Do you suffer from any of the following:
We respect that your medical information if private and sensitive to discuss, we ask these questions so that we can look after your safety. We can only do this with an accurate record of your health status.
Please list
If you answered yes to any of the above medical questions, Studio Torus advises that you gain medical clearance before commencing any exercise program
ACTIVITY HISTORY
PERSONAL OBJECTIVES
(optional) Goals and aspirations can be great motivations to stay committed and consistent with your health, fitness and wellness routines. However they can become overwhelming or a source of frustration if mindsets and circumstances change. Be sure to stay aware of these changes and re asses and reset your goals or perhaps take the focus of a specific goal and keep it simple to just show up and do what is best for you and you only at any given time. We are hear to support you, please feel free to reach out if you need some help with goals or just some simple encouragement, which we will be giving you anyway
TRAINING WORKLOAD
On a scale of 1 - 10:
PERSONAL GOALS
Can be short term, mid term, long term or just simply up to 3 goals you want to focus on
STATEMENT
I recognise that Studio Torus teachers are not able to provide me with medical advice regarding my medical fitness and that this information issued as a guidance top the limitations of my exercise ability
INDEMNITY
Subject to any breach by Studio Torus of the terms and conditions or its legal obligations(including any warranties implied by the consumer act 2010(Cth), I hereby agree that Studio Torus, its directors or nominated agent shall not be liable for any loss, damage or personal injury suffered by me, whether directly or indirectly arising out of any act or omission by studio torus, it’s directors or agents. I am aware of the possible health and safety risks associated with participating in physical exercise and consent to any reasonable exercise which may from time to time be strenuous. I have made studio torus, it’s directors or its agents aware of any relevant medical or health problems that I am currently or likely to suffer from and have obtained clearance from a registered medical practitioner to participate in physical exercise (applies to males over 35 and females over 45). I acknowledge sole responsibility for any personal equipment. I consent to receive medical treatment, which may be deemed necessary in the event of an injury, accident or illness. (if you are under 18 years of age, a signed consent of your legal guardian must be obtained).