Fitness Questionnaire

  • Fitness Questionnaire

    Regular physical activity has many health benefits however, some people should check with their doctor before they start. When planning to undertake physical activity, you should start by answering the questions below. If you are in any doubt, consult with your G.P. before commencing exercise. Please read the questions carefully and answer them honestly with YES or NO. If you answer Yes to any of them please provide more detail in the boxes.

  • Section 1: General Information

  • Format: (000) 000-0000.
  • What age are you?
  • How often do you currently exercise?
  • Approximately how many hours movement do you currently do? (e.g., housework, walking to work or school, home repairs, moving around at work, gardening, walking the dog etc)
  • When it comes to fitness what are your goals - Please Pick your top 3
  • What Type of exercise have you done in the past and liked - Pick all that are relevant

  • Section 2: General Health

  • Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
  • Do you feel pain in your chest when you do physical activity?
  • In the past month, have you had chest pain when you were not doing physical activity?
  • Do you lose balance because of dizziness or do you ever lose consciousness?
  • Do you have bone/joint problem that could be made worse by a change in your physical activity level?
  • Have you ever had any problems with your back?
  • Is your doctor currently prescribing any medication for blood pressure or a heart condition?
  • Is there any family history of heart disease, stroke, raised cholesterol or high blood pressure?
  • Do you suffer from diabetes/epilepsy/asthma?
  • Are you pregnant, or have you given birth in the last twelve weeks?
  • Do you have, or have you had any illnesses recently?
  • Have you recently had surgery?
  • Do you know of any other reason why you should not do physical activity?

  • CLIENT DECLARATION

    I have read and fully understood the Fitness Questionnaire. I confirm that, to the best of my knowledge, the answers are correct and accurate. I know of no reason why I should not participate in any exercise workout (except those mentioned above). Any equipment I use that is owned by DB Fitness & Nutrition I understand that I would be using entirely at my own risk and waive any legal recourse for damages to myself or property arising from my participation.  

    I have understood and answered all of the above questions honestly. I understand that I should not exercise if I feel unwell and that if my health changes, I should inform Deborah Branigan of DB Fitness and Nutrition.

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