C4 Fitness

home
training zone
daily workout
special populations
contact us
nutrition & lifestyle
about me

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

inspired

Personal information and questions:

Mr Mrs Ms

First name*:

Surname*:

Street / House number:

Post code:

City:

Telephone number:

Email*:

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

Yes No

Do you feel pain in your chest when you perform physical activity?

Yes No

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

Yes No

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes No

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?

Yes No

Do you know of any other reason why you should not engage in physical activity?

Yes No

If you have answered "Yes" to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.

Additional information

* Required fields.

Your personal data will be handled carefully and won't be shared with third person.

C4 Fitness

instagrams

Appointments available

Monday-Friday: 5:00am-8:00pm

Saturday: 6:00am-1:00pm

© 2015, C4 Fitness
All trademarks and registered trademarks appearing on this site are the property of their respective owners.

C4 Fitness

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

Personal information and questions:

C4 Fitness

instagrams

popular links

Appointments available