Physical Activity Readiness Questionnaire

Physical Activity Readiness Questionnaire
Gender *
Prefer *
I opt-in to receive text messages from Club Greenwood Instructors *
I prefer to work out: *

For most people, physical activity should not pose any problem or hazard. Many health benefits are associated with a sensible program of regular, moderate and adequate exercise. The completion of this physical activity readiness questionnaire is an important first step to allow you to begin or continue safely with physical activity. Determining physical activity readiness enables the identification for the small number of adults for whom some physical activity might be inappropriate, or those who should have medical advice concerning the most suitable type of activity.

Please read and answer these questions carefully:

1. Has your doctor ever said that you have a heart condition OR high blood pressure? *
2. Do you feel pain in your chest at rest, during your daily activities, OR when you do physical activity? *
3. Do you often feel faint or have spells of severe dizziness? *
4. Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? *
5. Are you currently taking any medication that affects your exercising ability? *
6. Has a doctor ever told you that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise, or might be made worse with exercise? *
7. Is there a good physical reason not mentioned here why you should not follow an exercise program? *

EXPRESS ASSUMPTION OF RISK/RELEASE OF LIABILITY

If I answered yes to any of the questions above, I recognize that Club Greenwood recommends that I visit a doctor before I begin an exercise program or use the Club, that I provide the Club with a medical release, and that I follow my doctor’s advice regarding exercise.
If my health changes so that I then would answer yes to any of the above questions, I agree to notify the Club of the health change and see a doctor before continuing or changing my exercise program.
I understand that for some individuals physical activity may lead to or worsen health problems. In exchange for my voluntary use of the Club, I hereby assume any and all risks from an exercise program and use the Club, including without limitation risks arising from a pre-existing medical condition, known or unknown. I hereby release the Greenwood Athletic Club Metropolitan District and its agents from any and all liability, claims, demands, actions, or rights of action, which may arise from my use of the Club including physical injury or death.

What are your fitness goals? *
When working out by yourself, what do you participate in the most? *
How self-motivated are you to make a lifestyle change? *
What types of training would you prefer? *
Are you interested in trying the following: *