Medical Questionnaire Please complete the fields below, the information you provide will help me tailor your initial free consultation and fitness programme. First Name *Email Address *Phone Number1. Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity? *YesNo2. Do you experience chest pain during or after physical activity? *YesNo3. Have you ever had chest pain when not engaged in physical activity? *YesNo4. Do you currently have a bone or joint problem that could be aggravated by the proposed physical activity? *YesNo5. Is your doctor currently prescribing drugs for your blood pressure or heart condition? *YesNo6. Do you know of any other reason why you should not engage in physical activity? *YesNo7. Do you have diabetes? *YesNo8. Do you smoke? *YesNoIf you answered "Yes" to one or more of these questions, it is advisable to consult with your healthcare provider before starting an exercise program. If you answered "No" to all questions, it is likely safe for you to start becoming more physically active. Before beginning any exercise program, it is recommended to start slowly and gradually increase intensity.Please provide additional details or comments if necessary:SignatureStart signing your signature hereYour browser does not support e-Signature field.Send Message
