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Remote Coaching Pre-Screen Questionnaire
Please fill out this form so that I know you're real and to give me a base to begin building your case file.
Email address *
Name?
Your answer
Age?
Gender you identify as?
Where in the world are you? (town / city and country)
Your answer
Can you balance on one leg with your eyes open for at least 15 seconds? (Please try it)
From standing, can you lie down on your back and get back up again without experiencing pain anywhere in your body?
Are you able to run fast over a very short distance (say 20 metres) without experiencing pain anywhere in your body?
Are you pregnant? Or do you think it's likely that you'll become pregnant within the next four months?
Has a doctor ever said that you have a heart condition AND that you should only do physical activity that's recommended by a doctor?
Do you ever feel pain in your chest when you do physical activity?
In the past month, have you experienced chest pain when you were not doing 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 might be made worse by a change in your physical activity?
Are you currently being prescribed any drugs for a heart condition or blood pressure?
Are you aware of any reason why you should not do physical activity?
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