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Name
Do you have a heart condition? *
Do you have chest pains when you exercise? *
Have you ever experienced any chest pains over the past month? *
Do you lose balance because of any unexplained dizziness?
Do you ever lose consciousness? *
Do you have bone or joint problems that could be made worse by a change in physical activity? *
Is your doctor prescribing you drugs for blood pressure or a heart condition? *
Are you aware of any other reason why you should not exercise? *
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