ONLINE SCREENING FORM | The EP Clinic

top of page

HOME
ABOUT US
SERVICES
TRAINING PACKAGES
CLASS TIMETABLE
OUR TEAM
CONTACT
Book Online
More

Use tab to navigate through the menu items.

Please fill out the following form to help us program the right exercises for you

Health Questionnaire

First Name

Phone

Email Address

Last Name

Date of Birth

Emergency name & number

Address

Medical History - please add all medical conditions (eg: high blood pressure, low back pain, depression, etc)

What type of exercise have you completed in the past?

None

Walking

Sport

Gym exercise or classes

Other

I accept The EP Clinic may contact me to discuss details in this form prior to my exercise appointment.

Thanks for submitting! Head over to our booking page to book your session!

G05/1 Capital place, Rouse Hill NSW 2155

admin@theepclinic.com | Tel: 0476 985 663

By appointment only

Mon - Thur: 6:30am - 6:30pm

Fri: 6:30am-11:30am

Privacy Policy

Terms & Conditions

© 2024 The EP Clinic

bottom of page