Physical Activity Readiness Questionnaire
Email address *
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
Do you feel pain in your chest when you do physical activity? *
In the past month, have you had 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 could be made worse by a change in your physical activity? *
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *
Are you pregnant, breastfeeding or had a baby in the last 6 weeks? *
Are you suffering from or have you ever suffered from mental health disorder i.e Depression, Anxiety, Eating Disorder *
Would you like to be added to my newsletter for updates on classes, PT and any offers? If yes, What is your email address? *
Your answer
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms