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Health Declaration

Please fill out the following health declaration form in order to participate in our activities. Submissions are valid for the entire duration of the course, the participant is required to inform if any changes occur.

First Name

Last Name

Email

Are you suffering from any medical condition: asthma, diabetes, high blood pressure, epilepsy, recovering from COVID-19? *

No

Yes

Are you taking any medication? Are you currently pregnant or you have been pregnant last 6 weeks? Did you have any surgery or medical treatment in last year? *

Yes

No

Date

Initials

I confirm that the information given in this form is true

Thanks for submitting!

FITSMILE SPORT & PERFORMANCE

Subscribe Form

Thanks for submitting!

Marta +48505647072, Alicja +48502512451

fitsmile.coaching@gmail.com

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