Physical Activity Readiness Questionnaire

Please fill out the following form to help us understand your physical condition.

Have you been hospitalized in the last 12 months?
Are you currently suffering from a medical condition, illness, or injury?
Has your doctor ever said that you have a heart condition and that you should only perfom physical ativity recommended by a doctor?
Do you feel pain in your chest when you perform physical activity?
In the past month, have you had chest pain when you are not performing any physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worst by a change in your physical activity?
Is your doctor currently prescribing any medication for your blod pressure or for a heart condition?
Do you know of any other reason why you should not engage in physical activity?

Get in Touch

Email. ms.shamika@gmail.com

Phone. 617.970.3352

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