Free Diet Plan and Workout Routine Personalization Form

The following questionnaire will screen out those with pre-existing conditions that make it unsafe to exercise without a doctor's supervision.

Is the answer to any of the following questions 'Yes'?

  • Has your doctor ever said that your have a heart condition and that you should only do physical activity recommended by a doctor?
  • Do you feel pain in your chest when you do physical activity?
  • In the past month, have you had chest pain when you were not doing physical activity?
  • Do you lose your balance because of dizziness or do you ever lose consciousness?
  • Do you have a bone or joint problem (for example, back, knee of hip) that could be made worse by a change in your physical activity?
  • Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure of heart condition?
  • Do you know of any other reason why you should not do physical activity?