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Medical history questionnaire

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

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Medical history questionnaire

Note: please answer the following question honestly and to the best of your ability 

This information will help me understand your needs and provide you a safe and effective service.☺️

1

Do you have any medical conditions or concerns that may affect your ability to participate in physical activities? (e.g., heart conditions, high blood pressure, diabetes)

Select one answer
2

If yes what medical condition do u have

Select one or more answers
3

Have you experienced any recent illnesses or injuries (within the past 6 months)?

Select one answer
4

Are you currently taking any medications or supplements?

Select one answer
5

Have you had any recent surgeries or hospitalizations?

Select one answer
6

Do you have any allergies or sensitivities?

Select one answer
7

Did you practiced any kind of sport before?

Select one answer
8

Rate your activity level from 1 to 5

EMERGENCY CONTACT INFORMATION 

9

Name of emergency contact

10

Phone number of emergency contact

Use digits only

DONE💪🏼


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