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Plattinum Training – Prior Injury and Health Disclosure Form

Email: chris.pst@yahoo.com

Purpose

Your safety is our top priority. Please list any prior injuries, surgeries, or medical conditions that may affect your ability to safely participate in physical training at Plattinum Training. This information will remain confidential and will only be used by your coach to modify exercises as needed.

Injury and Health History

1. Prior injuries (joint, muscle, bone, etc.):

2. Surgeries or medical procedures:

3. Current pain, limitations, or ongoing treatment:

4. Medications or conditions that may affect performance:

Health Acknowledgment

I understand that it is my responsibility to inform Plattinum Training staff of any changes in my health or injuries before participating in any class or activity.
I confirm that the information I’ve provided is accurate to the best of my knowledge.

Confidentiality Notice

All information submitted will remain confidential and will be used solely to ensure your safety and proper program design.