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Health Questionnaire
 

Please answer each question YES or NO

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?
6. Is your doctor currently prescribing drugs for your blood pressure or a heart con­dition? 
           
7. Are you pregnant?
 
          
8. Do you have any other health conditions or injuries?
 
9. Do you know of any other reason why you should not do physical activity?

If you have answered YES to any of the questions above, please advise your instructor of the details. 

If you can honestly answer NO to all of the above questions, you can be reasonably sure that you can start becoming much more physically active – begin slowly and build up gradually. Listen to your body and check with your instructor or your doctor if you have any concerns.
 

Please note:  
·        
If you sustain any injuries or your health changes so that you then answer YES to any of the above questions, please advise your instructor.
·        
If you are pregnant talk to your doctor and advise your instructor.
·         If you are not feeling well because of a temporary illness such as a cold or a fever you may wish to wait until you feel better before exercising.