WODSPACE Questionaire
Intake and participation questionaire for prospective clients
Please complete and submit the following form.
Full name
Your answer
Contact email
Your answer
Gender
Age Group
What is your weight and height?
Your answer
Occupation
Your answer
Location (City, Country)
Your answer
What are your training goals?
Required
Where will you be training?
Required
If you chose "At home", please list all equipment and resources you have access to.
Your answer
Medical History
Yes
No
Has your doctor ever informed you of an existing heart condition and that you should only engage in physical activity as prescribed by a health care professional?
Do you feel pain in your chest when you are physically active?
In the past month have you experienced chest pain while at rest?
In the past 6 months have you experienced dizziness, loss of balance, or suffered loss of consciousness during physical activity?
Do you have bone, joint or mobility problems that you feel could be worsened by physical activity?
Are you currently taking prescription drugs for high blood pressure or a heart condition?
Are you diabetic?
Have you had a sport-related injury that required physical therapy and/or surgery?
Do you know of any other medical reason why you should not do physical activity?
If you answered "Yes" to any of the above items please elaborate in the space below
Your answer
List exercises you are unable to perform and why.
Your answer
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