Muscle Intelligence Coaching

Exercise Readiness

[MIC - Client] Exercise Readiness Form


PLEASE READ CAREFULLY

Regular exercise is associated with many health benefits and increasing physical activity is safe for most people. What follows is called an "Exercise Readiness Questionnaire" and it highlights any medical conditions or physical inabilities that a client may need to speak to a physician about before they become more physically active. It also indicates opportunities or special considerations that your coach may need to take into consideration when designing your plans.

Please read each question carefully and answer every question honestly.

First name and last name
Has your doctor ever said that you have a heart condition and should restrict physical activity?
Has your doctor ever said that you have high or low blood pressure and should restrict physical activity?
Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?
Have you ever been diagnosed with any other chronic medical condition?
Are you currently taking prescribed medications for a chronic medical condition?
Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active?
Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.
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