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Lifestyle Questionnaire

A questionnaire for anyone starting PT with me. If you're in any doubt about your readiness for physical activity, please consult with your doctor or physician. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.

1. Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?
2. Do you frequently have pains in your chest when you perform physical activity?
3. Do you lose your balance due to dizziness or do you ever lose consciousness?
4. Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise programme?
5. Are you pregnant now or have you given birth within the last 6 months?
6. Have you had a recent surgery?
7. Do you have any chronic illness or physical limitations, such as asthma or diabetes? Please specify.
8. Do you have any injuries or orthopaedic problems, such as bursitis, bad knees, back, shoulder, wrist or neck issues? Please specify.
9. Do you take any medications, either prescription or non-prescription, on a regular basis? Please specify.
10. Do you smoke?
11. Do you drink alcohol?
14. Does you job require travel?
18. Do you frequently skip meals?
20. Do you frequently eat late at night?
22. Do you feel drops in your energy levels throughout the day?
28. Why are you reaching out to a personal trainer now?

Thanks for submitting!

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