HEALTH QUESTIONNAIRE

This form (Form) contains your client details and health disclosures to enable The Nest Climbing Gym Pty Ltd (ACN 681 776 054) (we, us or our) to provide you (Client) our services (Services) and your consent to receive our Services.

Where the Client is a minor, or is otherwise unable to complete this Form, an authorised representative such as a parent or legal guardian of the Client may sign this Form on behalf of the Client (Authorised Representative), and you in this Form will mean the Authorised Representative. You warrant and agree that, if you are completing and signing this Form on behalf of the Client, you have the required authority to do so and to provide us with the relevant information.

Please indicate if you have any of the following heath considerations:

  • Are you or could you be pregnant?

  • Are you a smoker?

  • Do you have any allergies?

  • Are you on any medications?

  • Do you have any chronic diseases?

  • Do you have any swelling?

  • Do you have any existing injuries?

  • Do you have osteoporosis/osteopenia?

  • Do you have Type 2 Diabetes?

  • Do you have amenorrhea?

  • Do you have a BMI 30 or higher?

If you answered Yes to any of the above, our Services may not be available for you.

We strongly recommend you consult a medical professional before using our Services and/or if you are unsure whether any of our Services are appropriate or right for you. The risk disclosures below are provided for general information purposes only, are not a substitute for professional medical advice and do not take into account your individual circumstances. Whilst we have used best endeavours to ensure that these risk disclosures are up to date and comprehensive, this list may not be complete and new information may become available from time to time. You should not disregard professional medical advice or delay in seeking advice because of something you have seen or read in this form. 

By signing this Form you agree to have read this Health Questionnaire and understand its contents. You agree that any undisclosed information may put you at risk of harm or injury are beyond the safety obligations of the Nest Climbing Gym.