Adult Ballet – pre-exercise screening form

Adult Ballet - pre exercise screening form

CLIENT INFORMATION - Private and confidential

1. Do you have any of the following? Comments below(Required)
2: Have you ever had treatment for any physical problems or injuries?(Required)
3: Have you been given medical clearance to attend a ballet class? Yes No(Required)
4: Are you suffering from any other medical problems that may affect your ability to exercise such as diabetes, low blood sugar, high blood pressure, low blood pressure? Yes No(Required)
5: Have you any additional health information that may be relevant? Yes No(Required)
6: How do you rate your overall posture? Excellent Average Poor Very Poor(Required)
I have read the above information and discussed it with my Adult Ballet teacher. I have advised my teacher of any physical conditions I have that would affect me doing exercise.(Required)
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