If you're answered is "NO" to all of the questions above, you are cleared for general physical activity. If you answered "YES" to one or more questions, then you need to consult your doctor to clarify if you're able to complete physical activities without restrictions.
I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes.