Have you, for any reason, been unable to exercise in the past? |
Yes
No
|
Have your physician ever advised you against exercising? |
Yes
No
|
Have you ever been suffered from any cardiac(heart) related illness? |
Yes
No
|
Have you ever been suffered from respiratory difficulties? |
Yes
No
|
Have you ever been suffered from fainting, migraines or loss balance? |
Yes
No
|
Have you ever been suffered from any bond, joint or muscle related disease? |
Yes
No
|
Is there any history of heart disease in your family? |
Yes
No
|
Have you experienced chest pain while exercising? |
Yes
No
|
Do you have high blood pressure? |
Yes
No
|
Do you have elevated cholesterol levels? |
Yes
No
|
Are you currently taking prescribed medication? |
Yes
No
|
If you answered 'yes' to any of the above, please give details below. All information is held in strictest confidence and accessible only by the gym manager and relavant staff.
|
Yes
No
|