Pre-Activity Readiness Questionnaire

Question Title

* 1. your name:

Question Title

* 2. your gender:

Question Title

* 3. your date of birth:

Date

Question Title

* 4. your occupation:

Question Title

* 5. Does your day-to-day involve any of the following?

Question Title

* 6. Do you experience chest pain, dizziness, or loss of balance when performing exercise?

Question Title

* 7. Please describe any current pains/injuries/medical conditions and any current medications

Question Title

* 8. Please describe your training history (prior athletics, programs, etc) and any hobbies or recreational activities

Question Title

* 9. Are you satisfied with your place in life?

Question Title

* 10. Which of the following best describes your fitness goals?

T