Online Personal Training Questionnaire

Do you feel pain in your chest at rest or when doing physical activity, or have you had chest pains within the last month?

Yes

No

Do you lose balance because of dizziness, or ever lose consciousness?

Yes

No

Do you, or have you ever suffered from: Diabetes, Epilepsy, Arthritis

Yes

No

Has your doctor or nurse ever said your blood pressure was very high?

Yes

No

Has your doctor ever said that you have bone or joint problems that may be made worse by exercise?

Yes

No

Is your doctor currently prescribing you drugs for blood pressure or heart condition?

Yes

No

Are you pregnant, or have you given birth within the last three months?

Yes

No

Do you know of any other reason at present why you should limit or delay physical exercise?

Yes

No