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Strength & Conditioning Questionnaire

    Your Info

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    Your Health / Fitness Goals
    What health goals would you like to achieve over the next 3 to 6 months?
    What are your main reasons for starting an S&C programme? (Tick all that apply)
    How would you describe your current general health and fitness?

    Have you done any structured exercise before? YesNo
    If yes, what did/do you do?

    What did you enjoy the most?

    What did you dislike / least enjoy?

    What would you say are the main barriers preventing you from exercising?

    Diet & Nutrition
    Would you like help and advice to change the quality of your eating habits? YesNo

    Lifestyle
    Do you smoke? YesNo
    If yes, how many per day:
    Do you drink alcohol? YesNo
    If yes, how much per week:

    Medical History
    Have you had a major illness or injury in the last 5 years? YesNo

    Are you receiving treatment for any diagnosed medical condition? YesNo

    Are you taking any prescription medication? YesNo

    Please indicate if you have ever experienced any of the following symptoms/ Do you:
    Ever get unusually short of breath with very light exertion? YesNo
    Ever have pain, pressure, heaviness or tightness in the chest area? YesNo
    Regular have unexplained pain in the abdomen, shoulders or arm? YesNo
    Please indicate if you have ever experienced any of the following symptoms/ Do you:
    Ever have severe dizzy spells or episodes of fainting? YesNo
    Regularly get lower leg pain during walking that is relieved by rest? YesNo
    Ever experience palpitations or irregular heartbeats? YesNo
    Are you currently pregnant or have you given birth in the last 6 months? YesNo

    Are these injuries aggravated by exercise? YesNo
    Are you receiving treatment for any structural problems? YesNo

    Confirmation