Fitness Assessment

Please complete the following online assessment.

Expect an email response back from a member of the Pure Fitness Solutions team.

Physical Activity Readiness Questionnaire
1. Has a doctor ever said you have heart trouble?
2. Do you frequently suffer from pains in your chest?
3. Do you often feel faint or have spells of severe dizziness?
4. Has a doctor ever told you that your blood pressure was too high?
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
6. Do you know of any other reason why you should not engage in a physical activity?
7. Are you over the age of 65 and not accustomed to vigorous exercise?
8. Have you consulted your physician regarding increasing your physical activity and/or having a fitness evaluation?
9. Heart condition?
10. Diabetes?
11. Asthma?
12. Arthritis?
13. Hernia?
14. Recent surgery?
15. High Cholesterol?
16. Knee Problems?
17. Back Problems?
18. Please list any medications/supplements you are currently taking (e.g. birth control, diet pills,aspirin, prescription medications etc.) and dosage and reason for taking if appropriate.

19. What are the fitness goals that you would like to achieve?

By submitting this form I am certifying that the above statements are true and correct.

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