angel girl
New member
I need to find the strength and weakness of this form i have found some that i think are weakness but then i think no wait they are strenght so if you could just help me a little bit or just give me some advice in what you think so i can go over it again
Name:Age:Gender:
Address:
Phone:
Date:
Have you ever had or suffer from any of the following?YESNO
Have you ever had a heart attack, coronary revascularisation surgery or a stroke?
Has your doctor ever told you that you have heart trouble or vascular disease?
Has your doctor ever told you that you have a heart murmur?
Do you ever suffer from pains in your chest, especially with exercise?
Do you ever get pains in your calves, buttocks or back of your legs during exercise, not due to soreness or stiffness?
Do you ever feel faint or have spells of severe dizziness, particularly with exercise?
Do you experience swelling or accumulation of fluid about the ankles?
Do you ever feel your heart is suddenly beating faster, racing or skipping beats, either at rest or during exercise?
Do you have chronic obstructive pulmonary disease, interstitial lung disease, or cystic fibrosis?
Have you ever had an attack of shortness of breath that developed when you were not doing anything strenuous, at any time in the last 12 months?
Have you ever had shortness of breath that developed after you stopped exercising, at any time in the last 12 months?
Have you ever been woken at night by an attack of shortness of breath, at any time in the last 12 months?
Do you have diabetes [IDDM or NIDDM]? If so, do you have trouble controlling your diabetes?
Do you have any ulcerated wounds or cuts on your feet that do not seem to heal?
Do you have any liver, kidney or thyroid disorders?
Do you experience unusual fatigue or shortness of breath with usual activities?
Is there any other physical reason or medical condition, or are you taking any medication(s) which could prevent you from undertaking an exercise program, or that you are concerned about?
Name:Age:Gender:
Address:
Phone:
Date:
Have you ever had or suffer from any of the following?YESNO
Have you ever had a heart attack, coronary revascularisation surgery or a stroke?
Has your doctor ever told you that you have heart trouble or vascular disease?
Has your doctor ever told you that you have a heart murmur?
Do you ever suffer from pains in your chest, especially with exercise?
Do you ever get pains in your calves, buttocks or back of your legs during exercise, not due to soreness or stiffness?
Do you ever feel faint or have spells of severe dizziness, particularly with exercise?
Do you experience swelling or accumulation of fluid about the ankles?
Do you ever feel your heart is suddenly beating faster, racing or skipping beats, either at rest or during exercise?
Do you have chronic obstructive pulmonary disease, interstitial lung disease, or cystic fibrosis?
Have you ever had an attack of shortness of breath that developed when you were not doing anything strenuous, at any time in the last 12 months?
Have you ever had shortness of breath that developed after you stopped exercising, at any time in the last 12 months?
Have you ever been woken at night by an attack of shortness of breath, at any time in the last 12 months?
Do you have diabetes [IDDM or NIDDM]? If so, do you have trouble controlling your diabetes?
Do you have any ulcerated wounds or cuts on your feet that do not seem to heal?
Do you have any liver, kidney or thyroid disorders?
Do you experience unusual fatigue or shortness of breath with usual activities?
Is there any other physical reason or medical condition, or are you taking any medication(s) which could prevent you from undertaking an exercise program, or that you are concerned about?