Has a Doctor / Medical Professional ever diagnosed you with a heart condition and indicated you should restrict your physical activity?
Has a Doctor / Medical Professional ever diagnosed you with a heart condition and indicated you should restrict your physical activity? Yes
Has a Doctor / Medical Professional ever diagnosed you with a heart condition and indicated you should restrict your physical activity? No
When you perform physical activity, do you feel pain in your chest?
When you perform physical activity, do you feel pain in your chest? Yes
When you perform physical activity, do you feel pain in your chest? No
When you were not engaging in physical activity, have you experienced chest pain in the past month?
When you were not engaging in physical activity, have you experienced chest pain in the past month? Yes
When you were not engaging in physical activity, have you experienced chest pain in the past month? No
Do you ever faint or get dizzy and lose your balance?
Do you ever faint or get dizzy and lose your balance? Yes
Do you ever faint or get dizzy and lose your balance? No
Do you have an injury or orthopaedic condition (such as a back, hip, or knee problem) that may worsen due to a change in your physical activity?
Do you have an injury or orthopaedic condition (such as a back, hip, or knee problem) that may worsen due to a change in your physical activity? Yes
Do you have an injury or orthopaedic condition (such as a back, hip, or knee problem) that may worsen due to a change in your physical activity? No
Do you have high blood pressure or a heart condition in which a Doctor / Medical Professional is currently prescribing a medication?
Do you have high blood pressure or a heart condition in which a Doctor / Medical Professional is currently prescribing a medication? Yes
Do you have high blood pressure or a heart condition in which a Doctor / Medical Professional is currently prescribing a medication? No
Are you 69 years of age or older and not used to being very active?
Are you 69 years of age or older and not used to being very active? Yes
Are you 69 years of age or older and not used to being very active? No
Do you know of any other reason you should not exercise or increase your physical activity?
Do you know of any other reason you should not exercise or increase your physical activity? Yes
Do you know of any other reason you should not exercise or increase your physical activity? No
I have read, understood and completed the above questionnaire and acknowledge that there are risks and dangers inherent in physical exercise and duly undertake the activity at my own risk. Any liability on the part of the operators is excluded unless negligence can be proven. I agree to observe the rules and conditions of membership. I also acknowledge that I must not use any piece of equipment for which I have not been shown how to use by an instructor. I confirm that the information that I have provided is correct at this time and should I become aware of any relevant changes to my health or condition, I will inform an instructor.
I have read, understood and completed the above questionnaire and acknowledge that there are risks and dangers inherent in physical exercise and duly undertake the activity at my own risk. Any liability on the part of the operators is excluded unless negligence can be proven. I agree to observe the rules and conditions of membership. I also acknowledge that I must not use any piece of equipment for which I have not been shown how to use by an instructor. I confirm that the information that I have provided is correct at this time and should I become aware of any relevant changes to my health or condition, I will inform an instructor. Yes
I have read, understood and completed the above questionnaire and acknowledge that there are risks and dangers inherent in physical exercise and duly undertake the activity at my own risk. Any liability on the part of the operators is excluded unless negligence can be proven. I agree to observe the rules and conditions of membership. I also acknowledge that I must not use any piece of equipment for which I have not been shown how to use by an instructor. I confirm that the information that I have provided is correct at this time and should I become aware of any relevant changes to my health or condition, I will inform an instructor. No