ONERO Program Pre-attendance Form

First Name *

Last Name *

Date of Birth *

Avanti Health Centre location *

Email Address *

Clinical Information Management

All member information collected at Avanti Health Centre is treated as ‘sensitive information’ and in order to protect your privacy, Avanti Health Centre operates in accordance with the Information Privacy Act 2009 (Qld).

We collect and use the information you provide to manage your healthcare. You can assist in maintaining the accuracy of your information by advising staff of any change to the information you provide, including any change of address, telephone number, GP etc.

Undergraduate students observing or participating in consultations have signed and are bound by strict confidentiality agreements. If your record is used as a teaching aide, your identifying information will be removed before use.

Your personal information will not be disclosed to any other third party without your written consent. In some circumstances we are legally obliged to disclose information about you, for example if records are subpoenaed for a court case or there is a legal requirement to collect information about your particular health conditions such as life-threatening diseases or diseases with high public risks, or if there is an immediate and specified risk of harm to an identifiable person or persons which can be averted only by disclosing information. We will ensure that any such disclosure is limited to only what is necessary.

Do you consent to your attendance and progress reports at Avanti Health Centre being made available to your nominated GP? *

YesNo

Pre-exercise participation screening questionnaire

Bone Health Specific Questions

Which areas of your body do you have reduced bone density? *

Lower BackLeft HipRight HipUnsure

What is your smoking history *

Never SmokedEx-SmokerCurrent Smoker

What is your current Alcohol Consumption? *

Less than 2 standard drinks per dayMore than 2 standard drinks per day

Do you have a history of bone fractures? *

YesNo

Please enter details - area of fracture and year of injury

Do you have a history of oral steroid medication eg prednisone *

YesNo

What is your current calcium-rich food consumption? *

3 or more servings of calcium-rich products per day Less than 3 or more servings of calcium-rich products per day

Include food and beverages

Please tick which of the following Osteoporosis treatments you are receiving *

Calcium supplementVitamin D supplementHormone Replacement Therapy (HRT)Parathyroid Injection - Forteo/TeriparatideProlia injection - Denosumab - (anti-resorption injection)Risedronate /Alendronate – anti osteoclastNone of the above

Medical History and Medications

Other Heart conditions

Other Respiratory conditions

Endocrine Condition - check all boxes that apply

Type 1 Diabetes Type 2 Diabetes Thyroid condition

Other Endocrine condition

Other neurological condition

Musculoskeletal Conditions - check all boxes that apply

Osteoarthritis Rheumatoid arthritis Other arthritis

Other Musculoskeletal conditions

Gastrointestinal Condition - check all boxes that apply

Irritable bowel syndrome Ulcerative colitis Crohn’s disease

Other GI condition

Mood and Mental Health Related Conditions - check all boxes that apply

Depression Anxiety

Other mental health condition

Medications *Excluding above Osteoporosis medications

Operations and year performed *

Onero Terms and Conditions Waiver

Please read and sign the waiver BEFORE ENTERING THE ONERO™ TRAINING FACILITY at Avanti Health Centres.

By SIGNING our waiver, you acknowledge that you have read these terms and conditions and you agree to be bound by them without limitation or qualification. If you do not agree to these terms and conditions, you do not have our consent and should cease to use our facility immediately.

The Onero™ licensee ("Us”, “We”, “Our" or “Avanti Health Centre”) reserves the right, at our discretion, to change, modify, add or remove portions of these terms at any time.

Therefore, we suggest that you review these terms periodically for changes. By using our facility after we have posted changes to these terms and conditions of use, you are agreeing to be bound by these terms as amended.

Enter Full Name *

has made an Application to participate in the Onero™ program, delivered by the licensee of the Onero™ program (Avanti Health Centres) AND by s igning this document you acknowledge that you understand and agree that:

1. Onero™ is the Trademark of an exercise program, including:

a. progressive resistance training

b. we ight-bearing impact activities

C. balance challenge tasks

2. You acknowledge that the program is generally designed for and targeted to men and women of any age, with low bone density with an emphasis on exercise which may minimise further loss of bone density.

3. It is recommended that you complete two sessions per week, with at least one rest day in between your sessions. You are able to choose the days and times of your sessions of the program within the limits of the timetable.

4. The Onero™ Licensee will ensure that a suitably qualified Coach is present at alltimes when you are training and that you will be able to interact with the Coach to the extent that is necessary and appropriate.

5. You acknowledge that the coaching you will receive and that yourparticipation in the program is for the purpose of exercise instruction and guidance. You also acknowledge that the Coaches are not qualified to diagnose or treat any illness whatsoever and that any concerns you have regarding any health conditions or illnesses should be brought to the attention of the relevant medical practitioner by you.

6. You acknowledge that you have informed the Onero™ licensee of any health conditions or illnesses you suffer or have suffered in the past which may, in the opinion of your medical practitioner, be relevant to your participation in the program and the manner in which participation in the program may affect you.

7. You acknowledge that the Onero™ program is not a cardiovascular training program, but that some hopping / jumping / high-impact activities could raise your heart rate above the resting rate for an amount of time.

8. You acknowledge that the Onero™ program does not include specific endurance training.

9. The Onero™ licensee maintains, at all times, public liability insurance to include active participation in the Onero™ program.

10. YOU ACKNOWLEDGE THAT you are agreeing to participate in the program voluntarily and that you release the Onero™ licensee, and The Bone Clinic Pty Ltd from any claims, demands, and actions at law that may arise as a consequence of your performance of Onero™ activities, including exercises, or any injury or condition that you may suffer.

11. There are no joining or exit fees or ongoing membership fees associated with the Onero™ program.

12. You may book multiple classes at a time, and you may change a booking up to 24 hours before a class.

13. Onero™ activities will not be held on Public Holidays or between Christmas and New Year.

14. Onero™ classes are capped at 8 attendees per class.

15. Comply with all Conditions of Entry and the guidelines in this agreement.

16. Inform us in advance if there are any risks to your health if you participate in fitness services and if required seek approval from your Doctor or General Practitioner.

17. If you are attending Avanti Health Centre for Onero™ program only, you are only permitted to access the Onero™ exercise area with your instructor.

18. Wait in the Avanti Health Centre reception area for your instructor to take you to the Onero™
exercise area.

19. For Onero™ attendees who are also Avanti Health Centre members, use of the Onero™ equipment is not permitted outside of Onero™ class times.

20. From time-to-time Avanti Health Centres may be required to make changes to the class timetable to suit demand.

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