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Dakota Personal Training & Pilates

Guest Waiver & Brief Medical History

Guest Waiver & Brief Medical History

Name(Required)
Address(Required)
Has your doctor ever said you had heart trouble?(Required)
Do you frequently have pains in your heart and chest?(Required)
Do you often feel faint or have or spells of severe dizziness?(Required)
Has your doctor ever said your blood pressure was too high?(Required)
Has your doctor ever told you that you had a bone or joint problem such as arthritis, that has been aggravated by exercise, or might be made worse by exercise?(Required)
Is there any good physical reason not mentioned here why you should not follow an exercise program even if you wanted to?(Required)
Are you over the age of 65 and not accustomed to vigorous exercise?(Required)
Have you traveled in the past 14 days?(Required)
Are you running a fever?(Required)
Do you have a cough not related to allergies?(Required)
Do you have an upset stomach?(Required)
Have you tested positive for COVID-19 in the past 48 hours?(Required)
" Please note we charge for sessions canceled with less than 24 hours notice!!!"

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