Health Questionnaire

Health Screening Questionnaire - Please tick appropriate box	Yes	No
Has a physician ever said you have a heart condition and you should only do physical activity recommended by a physician?	*
When you do physical activity, do you feel pain in your chest?	*
When you were not doing physical activity, have you had chest pain in the past month?	*
Do you ever lose consciousness or do you lose your balance because of dizziness?	*
Do you have a joint or bone problem that may be made worse by a change in your physical activity?	*
Is a physician currently prescribing medications for your blood pressure or heart condition?	*
Are you pregnant, or had a baby in the last 6 months?	*
Do you have insulin dependent diabetes?	*
Do you have any breathing difficulties or suffer from asthma?	*
Do you suffer from Epilepsy	*
Have you had a major operation. If so, specify	*
Do you know of any other reason you should not exercise or increase your physical activity

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