St. Michaels Athletics Club- Medical Questionnaire
Regular physical activity is usually very safe and beneficial for most people. By joining St. Michael’s AC you may become more physically active than you are now, so please begin by answering honestly the six questions in the box below.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
YES o NO o
2.Do you ever feel pain in your chest?
Do you ever feel pain in your chest?
YES o NO o
Do you lose your balance because of dizziness or do you ever lose consciousness?
YES o NO o
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?
YES o NO o
Is your doctor currently prescribing drugs for your blood pressure or heart condition?
YES o NO o
Do you know of any other reason why you should not do physical activity, for example pregnancy, diabetes, asthma, soft tissue injuries, etc.?
