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Full Name

Age

Gender

Email Address

Phone Number

Emergency Contact Name

Emergency Contact Number

Height (In CM)

Weight (In KG)

Social Media Id (Optional)

Are you aware of any heart condition? If yes, are you advised to limit physical activity by health care professional?

If yes, provide details

Do you feel chest pain when engaging in physical activity?
If yes, Do you experience chest pain even at rest and while performing day to day activities?

If yes, provide details

Have you ever fainted or felt dizzy,or lost consciousness during or after physical activity?

If yes, provide details

Do you have any existing joint, bone, or muscle problems?

If yes, provide details

Are you currently taking any prescribed or over-the-counter medications?

If yes, list them

Have you recently undergone any surgeries or medical procedures?

If yes, provide details

Are you suffering from any chronic health conditions like hypertension, diabetes, cholesterol, thyroid disorder?

If yes, are you on medication & please mention medications

Do you have any allergies, including to medications, foods, or other substances?

If yes, provide details

Are you pregnant or given birth within last 6 months?

If yes, provide details

Do you experience any issues with your menstrual cycle, such as irregular periods, excessive pain, or heavy bleeding, that might impact physical activity?

If yes, provide details

Is there anything else about your health, medical history, or lifestyle that you think we should know to create a safe and effective exercise plan for you?

If yes, provide details