Account Info

Demographics
Date:*
Name:*
Surname:*
Birthdate:*
Gender:*
E-mail:*
Address
Phone:*
Mobile Number:*
Proffession:*

GENERAL HEALTH QUESTIONS
Read the following 7 questions carefully and answer each one honestly: YES or NO.
1) Has your doctor ever told you that you have heart disease or high blood pressure?*
2) Do you feel pain in your chest at rest, during your daily activities or when you do physical activity?*
3) Are you losing your balance due to dizziness or have you lost consciousness in the last 12 months?*
4) Have you ever been diagnosed with another chronic condition (other than heart disease or high blood pressure)?*
5) Are you currently taking prescription drugs for a chronic condition?*
6) Do you currently (or have had for the last 12 months) a problem with a bone, joint or soft tissue (muscle, ligament or tendon) that could get worse as you become more physically active? Answer NO if you have had a problem in the past, but it does not limit your current ability to be physically active.*
7) Has your doctor ever said that you should exercise only under medical supervision?*
If you answered NO to all of the above questions, you can start physical activity.

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