FITNESS QUESTIONNAIRE - Secure Fitness

Name (First & Last) *
Date *
Age *
Weight *
Height (ft) *
Fitness Goal *
On a scale of 1-10, how serious are you about reaching your fitness goals? (10=Most) *
Does your occupation require repetitive movements? *
Have you been exercising consistently? *
Do you feel pain in your chest when performing physical activity? *
Has your doctor ever said that you have a physical conditions? *
Have you had any recent major or minor surgery? *
Are you pregnant now or have given birth within the last 6 months? *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Do you have any current injuries or past injuries? *
Do you have any physical limitations for any workouts? *
Does your current occupation require lots of sitting or extended periods of sitting? *
What is your current physical lifestyle? *
Are you currently taking any medications? *
Has your medical doctor ever diagnosed you with heart disease, hypertension, high cholesterol, or diabetes? *

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