Medical Form - Please answer to all questions by selecting Yes or NO
1. Have your doctor ever said you have a heart condition and you should not do physical activity?
YES , please provide details
NO
2. Do you feel pain in your chest when you do physical activity?
YES , please provide details
NO
3. In the past month, have you had a chest pain when you were not doing physical activity?
YES , please provide details
NO
4.Do you lose your balance because of dizziness or do you ever lose consciousness?
YES , please provide details
NO
5. Do you have a bone or joint problem (for example back, knee, or hip) that could be made worse by exercises?
YES , please provide details
NO
6. Is your doctor currently prescribing medication for your blood pressure or heart condition?
YES , please provide details
NO
7. Do you know of any other reason why you should not do physical activity?
YES , please provide details
NO