Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke?
Yes
No
Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?
Do you ever feel faint, dizzy or lose balance during physical activity/exercise?
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months?
Do you have any diagnosed muscle, bone, tendon, ligament or joint problems that you have been told could be made worse by participating in exercise?
If yes, please provide details.
Do you have any other medical conditions that may make it dangerous for you to participate in physical activity/exercise?
