Readiness for Exercise Form

Readiness for Exercise Form

Please complete the following form if you have booked a session at the Kettlebell Studio for the first time.

We need to have a basic understanding of your current state of health and level of fitness to check the suitability of kettlebell training for your individual needs. If we believe there is a danger that kettlebelling may be unsuitable for you based on your entries we will advise you further.

PLEASE COMPLETE:

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First name*

Last name*

Telephone number*

Email*

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I already booked my kettlebell taster session.

READINESS FOR EXERCISE QUESTIONNAIRE

Please answer all questions

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

2. Do you feel pains in your chest when you are involved in any form of physical activity?

3. In the past month, have you had chest pain when you were not doing physical activity?

4. Do you suffer from asthma or any other respiratory disorders?

5. Have you ever been told you have high blood pressure?

6. Have you ever been told you have low blood pressure?

7. Do you lose your balance because of dizziness or do you ever lose consciousness?

8. Do you have a bone or joint problem (for example, back, knee or hip)?

9. If yes, could it be made worse by a change in your physical activity?

10. Do you have any back problems or have you ever been told you have swayback, kyphosis, lordosis or flatback?

11. Are you currently taking any prescribed medication?

12. If yes, please tell us about your medication.

13. Do you know of any other reason why you should not do physical activity?

14. If yes, please tell us more here:

15. What is your current exercise time per week?*

Male Female

Nickname (for use on monitor software)

Weight (kg)

Height (feet and inches)

Date of Birth

- Statement: “I have read, understood and accurately complete this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise governed by heart rate training, and understand that my participation could involve a risk of injury”

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