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PRE-SCREENING QUESTIONNAIRE

This is to be completed prior to any physical activity at Steel Physique Ltd. It is important that you disclose ALL existing medical conditions so medical advice can be given prior to exercise by a qualified healthcare professional if needed. This questionnaire does not qualify as medical advice.

PERSONAL DETAILS

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MEDICAL HISTORY

Have you ever been told you have a heart condition?
Do you have unexplained pains in your chest during rest or physical activity?
Do you suffer from asthma and require medication?
Do you suffer from type I or type II Diabetes?
Do you have any muscle or joint injury that may limit or become aggravated by physical activity?
Do you suffer from any medical condition that could be made worse by exercise?
Do you often feel faint or suffer from dizziness?
Do you suffer from clinically high blood pressure (>140/90)?
Are you pregnant / post natal?
Have you had a recent operation / illness?
Do you know of any other reason why you should not exercise or increase your physical activity?

LIFESTYLE

Do you smoke?
In an average week, how many alcoholic drinks do you consume?
How do you consider your current nutrition?
How do you consider your current stress levels?
On average, how many times do you currently participate in physical activity each week?
On average, how many hours sleep do you get per night?

GOALS AND OBJECTIVES

DECLARATION

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