Pre-Exercise Fitness Questionnaire

 

In advance of taking part in one of our fitness sessions, please take a few moments to answer the questions below. 

All information you share is strictly confidential. 

If you answer yes to any of the medical condition questions, we will be in touch to discuss the suitability of participation. 

Thank you. 

 

 

Name *
Name
Sex *
Have you ever had any injury, illness, back or joint condition that you may feel could be aggravated by exercise? *
Have you ever suffered from Asthma, Diabetes, Epilepsy, Hernia, Dizziness, Circulation problems, Arthritis or an Ulcer? *
Have you ever had a Heart Condition, Stroke, Palpitations, Murmers or pains in the chest? *
Have either of your parents or brother/sister had any heart problems prior to the age of 60? *
Are you pregnant or recently given birth? *
Do you currently participate in regular exercise? *