2. Does your occupation require extended periods of sitting? 3. Does your occupation require extended periods of repetitive movements? 4. Does your occupation require you to wear shoes with a heel? 5. Does your occupation cause you anxiety? 6. Do you partake in any recreational activities? 7. Do you have any hobbies? 8. Have you ever had any pain or injuries (ankle, knee, hip, back ,shoulder ect.) (if yes please explain)9. Have you had any surgeries?10. Has a medical doctor ever diagnose you with a chronic disease such as coronary heart disease, coronary artery disease, hypertension, high cholesterol, or diabetes?11. Are you currently taking any medications? ( if yes please explain)Sign--------------------------------Date ------------