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  • H M S Training

    Physical Activity Readiness Questionnaire
  • Date Of Birth*
     - -

  • Medical History

  • Do you have, or have you ever had a heart condition, high blood pressure or ciculatory problem?*
  • Is there a history of heart disease in your family?*
  • Do you experience pain in your chest when exercising or at rest?*
  • Do you ever feel faint or suffer from dizzy spells?*
  • Do you experience joint or back pain or suffer from a joint condition that could be exacerbated by physical activity?*
  • Do you have diabetes?*
  • Do you have asthma?*
  • Do you suffer from epilepsy?*
  • Have you had any surgery or medical procedure in the part year that may affect your physical activity?*
  • Are you currently taking any prescribed medication?*
  • Are you pregnant?*

  • Disclaimer

    To the best of my knowledge, information, and belief, I have no physical restriction which would prohibit my participation in this fitness class/ Personal training provided by H M S Training. I understand that I am responsible for monitoring my own physical condition throughout the exercise program and should any unusual symptoms occur, I would cease my participation and notify the instructor immediately. In signing this consent form, I acknowledge that I have read this waiver of liability and fully understand its terms. I agree to accept the risk of such exercise and further agree to not hold H M S Training and its instructors liable for any and all claims, suits, losses, or related cause of action for personal injuries or damages that may arise from my participation.

  • Thank you for taking the time to fill out this questionnaire. H M S Training looks forward to seeing you in class soon.

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