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Physical Activity Readiness Questionaire
Has your Doctor ever said that you have a Heart condition or High blood Pressure?
YES
NO
Do you feel pain in your Chest at rest, during your daily activities or when you do physical activities?
YES
NO
Do you lose balance because of dizziness or have you lost Consciousness in the last 12 months?
YES
NO
Have you ever been diagnosed with any chronic Medical condition other than Heart disease or High blood pressure?
YES
NO
Are you currently taking a Prescribed Medication for a Chronic Medical Condition?
YES
NO
Do you currently have (or have had within past 12 months) a bone, joint, or soft tissue problem that could be made worse by becoming more physically active?
YES
NO
Has your Doctor ever said that you should only do Medically supervised physical activity?
YES
NO
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