Questionnaire

Please complete this form before participating in the MaKE my health program.

For any conditions that can be affected by exercise, you may be asked to consult your doctor and obtain a written medical clearance to exercise for your own well-being. 

The information contained will be treated as confidential, and will only be seen by Penelope Lane, your MaKE my health coach.

As a kind reminder,  it will be your responsibility to inform Penelope of any changes in your medical or physical condition during your MaKE my health program.

SPECIAL OFFER

Bring a Friend for Free!

Enter your details below & we will tell you how you can bring a friend for free (gift the program or split the cost!)
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