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Questionnaire & Measurements

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    1. Has your doctor ever said 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 chest pain when you were not doing physical activity?

    4. Do you suffer from asthma - if so, do you use inhalers?

    5. Are you diabetic?

    6. Do you have a bone or joint problem (e.g. back, knee or hip) that could be made worse by a change in your physical activity?

    7. Are you pregnant or have you been pregnant in the last 6 months?

    8. Are you currently taking any medication? If yes, what and for what reason?

    9. Do you suffer from regular back pain or have you had any back injury?

    10. Do you know of any other reason why you shouldn't exercise?

    I have read and understood this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.

    The file must be jpg and under 2mb.

    Please take your measurements today (In inches please!)

    Additional Information (Optional)