Medical Clearance Form
Name
*
First Name
Last Name
Email
*
example@example.com
Please Answer the following questions:
*
Rows
Yes
No
Have you ever been diagnosed with a heart condition by a physician and been told that you should only do physical activity at their recommendation?
Do you experience chest pain during physical activity?
Have you experienced chest pain in the last month that was not brought on during physical activity?
Have you ever lost consciousness or do you tend to feel dizzy frequently?
Do you have any bone or joint injuries or issues for which exercise would be contraindicated (not recommended)?
Do you have a blood pressure or heart condition that your doctor is prescribing drugs for?
Is there any other reason than those listed above for which you should not participate in physical activity without physician approval?
Submit
Should be Empty: