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Medical Questionnaire

Please fill out the following form to help us understand your physical condition. Please note, If you engage in the exercise, you agree that you do so at your own risk.

First Name

Email Address

Last Name

Date of Birth

Do you have diabetes / joints, back problems / respiratory illness / epilepsy / high blood pressure / family history of heart attack? *

No

Yes

Has a doctor ever said that you have a heart condition / feel pain in your chest and/or you should only do physical activity recommended by a doctor? *

No

Yes

If you answered yes to any question, please elaborate

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

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Get In Touch

Edinburgh, United Kingdom

fitlifefitnesswellbeing@gmail.com Tel: +44 784 628 6603

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