Real Girls Sweat Adult Pre-Exercise Screening Name* First Last Today's Date* DD slash MM slash YYYY Phone*Email* DOB* DD slash MM slash YYYY Best Time of Day to Call* Gender*FemaleMale1. Has your doctor ever told you that you have a heart condition or have ever suffered a stroke?* Yes No 2. Do you ever experience unexplained pains in your chest at rest or during physical activity / exercise?* Yes No 3. Do you ever feel faint or have spells of dizziness during physical activity / exercise that causes you to lose balance?* Yes No 4. Have you had an asthma attack requiring immediate medical attentions at any time over the last 12 months?* Yes No 5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?* Yes No 6. Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physicl activity/exercise?* Yes No 7. Do you have any other medical condition/s that may make it dangerous for you to participate in physical activity/exercise?* Yes No IF YOU ANSWERED YES to any of the above 7 questions please list details below and seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/exercise.Please list any existing injuries and briefly outline your current fitness activity below.I hereby understand that by using Real Girl Sweat services I am participating in sporting/recreational activity which involves obvious risk. I also note that Civil Liability Act 2002 NSW states that no duty of care exists when reasonable warning of risk is given. I acknowledge that I am participating in activities of risk and I acknowledge this waiver as my understanding of the obvious risk.* Yes I agree to the above.