Health Questionnaire Name * First Name Last Name Email * Contact Number * Country (###) ### #### Age * Emergency Contact Name * First Name Last Name Emergency Contact Number * Country (###) ### #### Muscle & Joint Issues Describe any muscle and joint problems you may have: Medical Conditions List any medical conditions you have: Are you pregnant or recently had a baby? * Yes No I consent to taking part in an exercise session with Maria Fernandez-Corugedo * Yes No I have consulted with my Physiotherapist/Medical Professional regarding this exercise programme (if relevant) Yes No Thank you!