Health Questionnaire

First name

Address

Gender

Last name

Phone

Date of Birth required

Occupation

Do you have any recent injuries?

Have you ever suffered chest pains or has your GP said that you have heart issues?

Do you often feel faint or have spells of dizziness?

Have you ever suffered from high or low blood pressure?

Has a doctor said that you might have bone or joint problems, such as arthritis, that can been aggravated by exercise? If yes, please state below

Are you,(if yes please list trimester or number of weeks) or have you been pregnant in the last 3 years?

Do you currently take any medication?

Do you suffer from asthma or other breathing difficulties?

Do you suffer from other conditions such as epilepsy, diabetes or any allergies?

Do you know any other reason not mentioned above that means you should not exercise or do physical activity?

How would you describe your current level of fitness?

Describe your current fitness regime or past activity levels

Thank you!

Your information will be treated confidentally.