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Physical Activity Readiness Questionnaire


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The Questions below will indicate if you need to check with your Doctor before you start exercising. If you are over 69 years of age and not currently active, you should consult with your doctor prior to commencing an exercise regime.

Please read the questions below and answer honestly:


Has your Doctor ever said that you have a heart condition and you should only do physical activity
recommended by a doctor?


Do you have high blood pressure?


Do you have any pain in your chest when you do physical activity?


Do you lose your balance because of dizziness or do you ever lose consciousness?


Do you have a bone or joint problem that could be made worse by a change in your physical activity?


Are you currently taking any prescribed medication excluding the contraceptive pill?


Do you know of any reason why you should not be undertaking physical activity?


If you have answered any of the above questions with a yes you will need to consult with your GP BEFORE you start becoming more physically active or BEFORE you have a fitness appraisal. We will need written confirmation from your GP before you begin using the gym.


Declaration


I have read, understood and completed the above questionnaire and acknowledge that there are risks and dangers inherent in physical exercise and duly undertake the activity at my own risk. Any liability on the part of the operators is excluded unless negligence can be proven. I agree to observe the rules and conditions of membership. I also acknowledge that I must not use any piece of equipment for which I have not been shown how to use by an instructor. I confirm that the information that I have provided is correct at this time and should I become aware of any relevant changes to my health or condition, I will inform an instructor.