Thrive Recovery Health Questionaire

Client Health Screening

Health Screening Questionnaire

Please complete this form honestly and accurately. The information you provide helps Thrive Recovery determine whether our recovery therapies are suitable for you and enable us to off you the best Recovery treatments. Your information will remain confidential and handled in accordance with our Privacy Policy.

First Name

Last Name

Date of Birth

Date Completed

Contact Information

Your Address

Address

City

State

Zip Code

Email Address

Phone Number

Emergency Contact Name

Emergency Contact Number

Medical Information

Have you been diagnosed with any medical conditions?

Yes

Please provide details

Are you currently under the care of a doctor or specialist?

Yes

If yes, please explain

Have you had surgery in the past 12 months?

Yes

Provide details

Do you currently have any injuries?

Yes

Provide details

Medications

Are you currently taking any prescribed medications?

Yes

If so please list here

Other Health Conditions

Cardiovascular Health | Respiratory Health | Neurological Conditions | Musculoskeletal Conditions | Other

Services

Red Light Therapy

Photosensitivity

Taking photosensitising medication

Active skin cancer in treatment area

Eye conditions requiring protection

None of the above

Lifestyle

How many days per week do you exercise?

1 - 2

3 - 4

Additional Information

Member Declaration

Thank you for taking the time to share this information. It helps our team tailor a safe, effective recovery experience — so you can get the most out of every Thrive session.

Please complete all declarations

I declare that the information provided is true and accurate to the best of my knowledge.

I understand that withholding relevant medical information may increase my risk of injury or adverse events.

I agree to notify Thrive Recovery if my health status changes.

I understand that completion of this questionnaire does not guarantee my suitability for every therapy offered.

I acknowledge that Thrive Recovery may recommend that I seek medical clearance before using certain recovery services.

Recharge. Rebalance. Recover.