Fitness Assessment Form

If you have any questions with this form, or prefer direct contact, email [email protected]

Name
Pitzer Affiliation(Required)

Health Questionaire

Please answer the following
Has your doctor ever said that you have a heart condition and should only perform physical activity recommended by a doctor?(Required)
Do you feel pain in your chest when you perform physical activity?(Required)
In the past month, have you had chest pain when you were not performing any physical activity?(Required)
Do you lose balance because of dizziness or have you ever lost consciousness?(Required)
Do you have bone or joint problems that could be worse by a change in your physical activity(Required)
Is your doctor currently prescribing any medication for blood pressure or a heart condition?(Required)
Do you know of any other reason wny you should not engage in physical activity?(Required)

Agreement and Concent

Consent(Required)