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Physical Activity Readiness Questionnaire
The answers you provide will help us to ensure that you take part in our sessions with minimal risk. Please answer as accurately and as honestly as you can.
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Your email
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
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Yes
No
Do you feel pain in your chest when you perform physical activity?
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Yes
No
In the past month, have you had chest pain when you were not performing physical activity?
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Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
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Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
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Yes
No
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
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Yes
No
Do you know of any other reason why you should not engage in physical activity?
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Yes
No
Please enter any additional information below regarding any aspects of your health that could potentially impact your safe participation in physical activity.
Your answer
If you have answered 'yes' to any of the previous questions, have you obtained written permission from your doctor allowing you to take part in physical activity?
Yes
No
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Do you give permission to have your photo taken during sessions with the sole purpose of providing promotional content for Wolfpaq.co?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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