Questionnaire
Physical Activity Readiness and Medical Questionaire
Has a doctor ever said you have a heart condition? If so, explain further please.*
Do you feel pain in your chest while performing physical activity?*
In the past month, have you had chest pain when you were NOT performing any physical activity?*
Does your occupation involve any of the following?*
Do you partake in any recreational activities? Ex: sports, outdoors, leagues, etc.*
Do you have any hobbies? Ex: gardening, working on cars, knitting, etc.*
Do you have any injuries currently affecting you? If so, please describe.*
Have you had any significant injuries in the past? Please include details and an estimate of when it occured. *
Have you had any surgeries? Please describe what you had and when you had them.*
Has a medical doctor ever diagnosed you with a chronic disease? If so, please elaborate.*
Are you currently taking any medication, presciption or otherwise? If so, please elaborate.*