top of page

Pre-Exercise Questionnaire


Do you have any of the following conditions? Asthma, Epilepsy, Back problems, Muscle problems, Diabetes (Type 1/2)
Yes
No
Do you have a heart condition and/or have you ever suffered from a stroke?
Yes
No
Do you have high cholesterol or have you been told you do in the past 6 months?
Yes
No
Do you ever experience unexplained pains or discomfort in your chest at rest or during physical exercise?
Yes
No
Do you ever feel faint, dizzy or lose balance during physical exercise?
Yes
No
Do you have any conditions that may require special consideration for you to exercise?
Yes
No

If you answered NO to all of the above questions, please write 'N/A'.

Do you take any medication for a diagnosed condition that has not been listed already?
Yes
No

If you answered NO to all of the above questions, please write 'N/A'.

Do you smoke? (Cigarettes/E-Cigarettes/Vapes)
Yes
No
On Occasion
Have you spent time in the hospital (including day admissions) for any conditions/illness/injury during the last 6 months?
Yes
No
Are you pregnant or have you given birth within the last 12 months?
Yes
No
I have given birth within the last 12 months
Do you have any diagnosed muscle, bone, tendon or ligament problems that could be made worse by participating in exercise?
Yes
No
I am not sure
Please select the goal/s most suited to you:

Please read the following statement and sign in agreement as 'The Recipient':


"I (The Recipient), have provided the correct information to YOUR KYND (Bodi Unlimited Pty Ltd) and will hold the responsibility to update them with any changes if they occur. I have re-read the Pre-Exercise Questionnaire and can confirm that I (The Recipient), have provided all true information about my health status and wellbeing."

bottom of page