Before you join in any Power Plate Remote classes provided to you by MyZone, please answer the questions below.
This form is used to identify if it is safe for you to commence unsupervised exercise. Please read the questions carefully and answer each one to the best of your knowledge.

Your name

Your email

Has your doctor ever said that you have a heart condition or have you ever suffered a stroke?
yesno

Do you feel unexplained pain in your chest at rest or when you do physical activity?
yesno

Do you ever lose your balance because of dizziness during physical activity?
yesno

Have you had an asthma attack requiring medical attention at any time over the last 12 months?
yesno

If you have diabetes, have you had trouble controlling your blood glucose at any time over the last 6 months?
yesno

Do you have a bone or joint problem that could be made worse by participating in exercise?
yesno

Do you have any other medical condition that may make it dangerous for you to participate in exercise?
yesno

If you answer YES to any of the questions it is not recommended that you start exercising until you have first consulted your GP for clearance and advice.

FINALLY,
Please rate your fitness scale:
Just starting outI move a few times a weekAverage for my ageI can do most activities without getting out of breathSuperfit

And tell us what you would most like to get out of your remote Power Plate classes (select all that apply)
Get fitGet strongBuild bone densityImprove balanceImprove mobilityImprove circulationImprove body compositionImprove sport performanceRelax and recoverInjury rehabilitationImprove celluliteImprove cognitive functionOther reasons

If you have any known medical condition, or any physical limitation on your ability to exercise, it is strongly recommended that you seek the advice of a physician before using Power Plate in order to avoid possible injury.

If, while using Power Plate, you experience any dizziness, faintness, shortness of breath, or pain, you must stop using the machine immediately and consult a physician. Failure to do so could result in personal injury.

By clicking on the SUBMIT button below you are acknolwedging that the answers you have provided above regarding your health and personal information are, to the best of your knowledge, correct.
You understand that participating in physical activity and exercise can carry a risk, and you accept all responsibility for that risk.
You acknowledge that you will not be receiving any personalised exercise advice for these remote exercise classes.

If you have any queries or concerns please CONNECT with your MyZone Power Plate Coach via the Myzone app to discuss.