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Online Medical Questionnaire

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active

If you are planning to become much more physically active than you are now, start by answering the seven questions below


 If you are between the ages of 15 and 69, and answer yes to any questions you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

Common sense is you best guide when you answer these questions. Please read the questions carefully and answer each one honestly by checking YES or NO.

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month have you had a pain in your chest when you were not doing physical activity?
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
6. Is your Doctor currently proscribing you with drugs (for example water pills) for your blood pressure or heart condition?
7. Do you hav Asthma

Thanks for submitting!

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