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  • Health History

  • Regular physical activity is safe for most people. The American College of Sports Medicine (ACSM) standards indicate that some individuals should check with their doctor concerning their participation in an exercise program. To help us determine if you should consuit with your doctor, rean the following questions carefully and answer each one honestly. If you answer "YES" to any one of questions 1-12, or answer "YES" to 2 or more of questions 13-19, we will require your private physician's concurrence in order for you to participate in exercise programs at Shsrpa. All information will be kept confidential.

  • Please check Yes or No

  • I have read, understand, and completed this questionnaire. Any questions that I had were answered in my full satisfaction. I understand I will complete an updated Health History Questionnaire if I have a known change in my health status