Health & Fitness Enquiry for Online Coaching

Name? *

Age? *

Any medical condition? *
(Heart Disease, High BP etc)

Yes

No

Do you feel pain in your chest when you do physical activity? *

Yes

No

Any bone or joint issue? *

Yes

No

Is your doctor currently prescribing drugs? (BP or Heart Condition)? *

Yes

No

Recent chest pain while not doing any physical activity? *

Yes

No

Dizziness or lose consciousness? *

Yes

No

Do you smoke or drink? *

Yes

No

Anything else which is important and we should know? *