For most people, physical activity should not pose any problem or hazard. This questionnaire has been designed to identify adults for whom physical activity might be inappropriate or for those who should seek medical advice concerning the type of activity most suitable for them.
If you answer YES to any of the first FOUR questions you should consult your doctor prior to undertaking any fitness sessions and get your doctor’s written consent to participate.
PLEASE NOTE THIS INFORMATION IS PRIVATE AND CONFIDENTIAL BETWEEN YOURSELF AND THE INSTRUCTOR.
All information provided will be held in the strictest confidence.
PLEASE READ THESE QUESTIONS CAREFULLY AND ANSWER EACH ONE HONESTLY:
The instructor assumes no liability for persons who undertake physical activity and, if in doubt after completing this questionnaire, consult your doctor prior to physical activity.
I hereby confirm that I have read, understood and completed this questionnaire fully.