Medical Questionnaire
Medical Questionnaire
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Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity? *
Do you take any medications, either prescription or non-prescription, on a regular basis? (If 'YES' what is the medication for?) *
Do you have any injuries or orthopedic problems such as bursitis, bad knees, back, shoulder, wrist or neck issues? *
Do you have any chronic illness or physical limitations such as Asthma, diabetes? *
Have you had a recent surgery? *
Are you pregnant now or have you given birth within the last 6 months? *
Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, anorexia, bulimia, anemia, epilepsy, respiratory ailments, back problems, etc.)? *
Do you lose your balance due to dizziness or do you ever lose consciousness? *
Have you had chest pain when you were not doing physical activity? *
Do you frequently have pains in your chest when you perform physical activity? *
How does this medication affect your ability to exercise or achieve your fitness goals? *
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