Gym Cancellation Form

Date

1. How likely are you to recommend us to your friends and family?

0 - not likely12345678910 - very likely

2. Reason for cancellation:

Moving awayFinancial ReasonsMedical ReasonsTime constraintsDoesn’t suit needsNot using enoughOther (Specify below)

3. Preferred Cancellation date

Please note that a minimum of 14 days’ notice is required to cancel your membership, during which time any fees due will be payable. Access to the gym will remain during this pre-paid period.

By signing this form, I accept all the conditions of cancellation and authorise In Balance Physiotherapy and Fitness to proceed with cancellation of my gym membership.