Fit Stuff

Pre-exercise Questionnaire

    All fields below are required

    Your Name

    Your Email

    Date of Birth

    Gender
    MaleFemale

    1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
    YesNo

    2. Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?
    YesNo

    3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
    YesNo

    4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
    YesNo

    5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?
    YesNo

    6. Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?
    YesNo

    7. Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?
    YesNo

    By submitting you confirm to the following: “I believe that to the best of my knowledge, all of the information I have supplied within this tool is correct.”