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Medical History
Are you currently under a doctors care?
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Yes
Do you take any medication
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No
Yes
Please specify your medication
Have you been recently hospitalised?
*
No
Yes
Please specify why you have been in hosptial
Do you smoke/vape?
*
No
Yes
Do you drink alcohol?
*
No
Yes
Approximately how much do you drink per week?
Are you/could you be currently pregnant?
*
No
Yes
Approximately how many weeks pregnant are you?
Do you have any of the following conditions?
High Blood Pressure
*
No
Yes
Low Blood Pressure
*
No
Yes
High Cholesterol
*
No
Yes
Diabetes
*
No
Yes
Do you have any other medical conditions that may impact your physical fitness/ ability to exercise?
Do you have a family history of any of the following conditions?
Heart Conditions
*
No
Yes
High Blood Pressure
*
No
Yes
Stroke
*
No
Yes
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