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Inquiry form

First Name *

Surname *

Date of birth *

Phone Number *

WhatsApp *

Email Address *

Identification Number (CPR/Smart Card/Passport) *

Job Title *

Do you have any Learning needs?

Additional Information

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

Yes

No

Do you feel pain in your chest when you do physical activity? *

Yes

No

In the past month, have you had chest pain when you were not doing physical activity? *

Yes

No

Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity levels? *

Yes

No

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart conditions? *

Yes

No

Do you know of any other reason why you should not do physical activity? *

Yes

No