Pre-Activity Readiness Questionnaire

Pre-Activity Readiness Questionnaire

There are countless benefits to engaging in an exercise regime. Before you partake in exercise though, it’s important to ensure you are physically prepared and fit to start. Please fill out the following information truthfully to the best of your knowledge.
Has your doctor ever said that you have a heart condition, and that you should only do physical activity when recommended by a medical professional?

YesNo
Do you experience chest pains when you take part in physical activity?

YesNo
In the last month, have you experienced chest pain while not doing physical activity?

YesNo
Do you lose balance because of dizziness or do you ever lose consciousness?

YesNo
Do you have a bone or joint problem (back, knee or hip for example) that could be worsened due to physical activity?

YesNo
Is your doctor currently prescribing you with heart or blood pressure medication?

YesNo
Do you know of any other reason that you should not partake in physical activity?

YesNo
If you have answered...

YES to one or more of the above questions

We would recommend you consult your doctor to clarify that it is safe for you to become physically active at this present time.

NO to all questions

It is deemed safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels.

Please note: if your health changes from this point onwards so that you then answer yes to any of the above questions, please let your professional know.
I have read, understood and accurately completed this form. I confirm that I am voluntarily engaging in an acceptable level of exercise and my participation involves a risk of injury.
Name

First NameLast Name
Date

MonthDayYear
Date
Signature

Clear
One final thing...

You are in complete control of your workouts and have the right to terminate any given exercise should you feel pain, discomfort or require to stop for any other reason. Results may vary and we cannot guarantee any specific outcome. Please acknowledge that you are also responsible for your own decisions with regards to sleep, exercise, recovery, nutrition and an overall healthy lifestyle around the sessions. We cannot be held responsible for choices made beyond the recommendations and what has been advised and discussed during sessions.
Should be Empty: