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Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? |
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In the past month, have you had chest pain when you were not performing any physical activity? |
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Do you lose your balance because of dizziness or do you ever lose consciousness? |
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Do you have a bone or joint problem that could be made worse by a change in your physical activity? |
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Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? |
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Do you know of any other reason why you should not engage in physical activity? |
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Have you been advised by a medical professional to increase or adapt your activity levels? |
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Have you ever had any injuries or chronic pain? (If yes please provide further detail below) |
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Have you ever undergone any surgeries? (If yes please provide further detail below) |
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Has a medical professional ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol or diabetes? (If yes please provide further detail below) |
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Are you currently taking any medication? (If yes please provide further detail below) |
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