Health and Fitness Questionnaire

June 13, 2011

A health and fitness questionnaire is typically used by personal trainers or gyms to take an account of a person’s fitness levels and overall physical condition. Anyone who wishes to engage in regular exercise or strenuous physical activity for the first time is required to fill in a health and fitness questionnaire. It is also necessary for elderly people who do not exercise regularly. The information that is provided can determine whether or not a visit to one’s physician will be required before physical training. The information is essential and confidential because it may be necessary to consult a doctor if the answers indicate a lack of fitness or good health.

Sample Health and Fitness Questionnaire

All the information provided is strictly confidential.

Has a physician treated you for any form of heart disease in the recent past?  …………………………………..

Are you required to exercise under medical supervision?  ………………………………………………………………..

Does physical activity induce pain in your chest?  ……………………………………………………………………

Are there any other activities that trigger pain in your chest?  ……………………………………………………..

Have palpitations ever been a problem for you?  …………………………………………………….

Do you ever feel faint or nauseous?  ………………………………………………………………..

Have you had high blood pressure before?  …………………………………………………….

Has high blood pressure medication ever been prescribed to you?  ……………………………………..

Do you find it difficult to breathe when you exert yourself?  ……………………………………………….

Are you aware of any medication you are taking?  ……………………………………………………………

Are you currently pregnant?  …………………………………………………………

Have you had a child within the last two months?  ……………………………………………..

Have you had surgery recently?  ……………………………………………………..

Do you know of any condition that hinders you from physical exercise?  ……………………………………….

Do you have a high level of cholesterol?  ……………………………………………………

Download Health and Fitness Questionnaire in Word Format

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