Physical Activity Readiness QuestionnairePlease fill in this form before your first session Name * First Name Last Name Email * Has your doctor ever said that you have a heart condition, and that you should only perform physical activity recommended by a doctor? * Yes No Do you feel pain in your chest when you perform physical activity? * Yes No In the past month, have you had chest pain when you were not performing any physical activity? * Yes No Do you lose your balance because of dizziness or do you ever lose consciousness? * Yes No Do you have a bone or joint problem that could be made worse by a change in your physical activity? * Yes No Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? * Yes No Do you know of any other reason why you should not engage in physical activity? Or is there anything else you'd like to tell us about your health? * Yes No If you answered Yes to any of the above questions, please give more details here: Thank you!
