Rockwell Fitness

Free Health Assessment

Filed under: Rockwell Fitness — Rick Rockwell @ 4:26 am

If you are interested in taking a free health assessment, then please fill out the form below. All information will be kept private. A Rockwell Fitness representative will contact you to discuss your results.

Name
Email
Age
Gender
Height
Weight
1) Has your doctor ever told you that you have a heart condition?
2) Do you experience chest pain when you are physically active?
3) In the past month have you experienced chest pain when not performing physical activities?
4) Do you lose balance due to dizziness?
5) Have you ever lost consciousness when performing a physical activity?
6) Do you have any bone issuses that could worsen due to an increase in physical activity?
7) Do you have any joint issues that would worsen due to an increase in physical activity.
8) Is your physician currently prescribing medications for high blood pressure or a heart condition?
9) Is there any other reason why you shouldn't participate in a physical activity program?
If you have answered yes to any of these questions please explain here.
1) Have you ever had a stroke?
2) Do you have diabetes?
3) Do you have asthma?
4) Do you have any other respiratory conditions?
5) Do you have any orthopedic conditions that would restrict you from doing physical activity?
6) Do you currently smoke?
7) Do you currently consume alcohol?
8) In the past 6 months have you experienced any back pain that prevented you from any physical activity?
9) Do you consume any other harmful items not previously mentioned?
10) Are you pregnant?
11) Are you currently taking any medications that might impact your participation in a physical activity program?
If you answered yes to any of the previous 11 questions, please explain here.
1) How man days a week are you exercising?
2) How long do your workouts last?

 

 
 
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