Maries Moves

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Users

Everyone with an account on Maries Moves. View their health questionnaire or reset it so they fill it in fresh.

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User

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New customer

Add user

Add a customer who paid in person. If they later sign up using the same email, their records link up automatically. A welcome email is sent to them.

Contact details

Full name*

Email*

Phone (optional)

Fill in their health questionnaire on their behalf
Only tick this if the customer can't do it themselves (e.g. not online and they've told you their answers in person). Otherwise leave unticked — they'll be prompted to fill it in when they first sign in.

Fill in the customer's health screening. Same form your customers fill in themselves.

Their details

Full name

Email

Date of birth

DD/MM/YYYY

Emergency contact

Emergency contact name (optional)

Emergency contact number (optional)

Health screening

Has a doctor ever told you that you have a heart condition?

Yes No

Please give brief details (optional)

Do you experience chest pain during physical activity?

Yes No

Please give brief details (optional)

Do you ever feel faint or dizzy during exercise?

Yes No

Please give brief details (optional)

Do you have any bone, joint or muscle problems that could be made worse by exercise?

Yes No

Please give brief details (optional)

Do you have any lung or breathing condition?

Yes No

Please give brief details (optional)

Are you on any medication that might affect your ability to exercise?

Yes No

Please give brief details (optional)

Is there anything else you'd like Marie to know before your first session? (optional)

I confirm the above information is accurate and I am happy to participate in gentle exercise classes. I understand that I take part in these classes at my own risk. Maries Moves is not liable for any injury or illness arising from my participation.

Health questionnaire

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