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Has the Doctor ever told you that you have heart condition or have you ever suffered a stroke?
Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?
Do you ever feel faint or have spells of dizziness during physical activity that causes you to lose balance?
Have you had an asthma attack requiring immediate medical attention at any time over the last 12months
If you have diabetes type I or I I have you had trouble controlling your blood glucose in the last 3month
Do you have any diagnosed muscle, bone or joint problems that you have told could be made worse by participating in physical activity/exercise?
Do you have any other medical condition that may make it dangerous for you to participate in Physical exercises?
If you have answered ‘yes’ to any of the 7 questions, a formal letter of clearance will need to be signed by your GP or Allied health professional and passed on TCFA prior to undertaking physical activity/exercise. If you answered ‘no’ to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light moderate intensity physical activity.

Tick any of the following problems you have ever experienced:

Low back pain
Mid back pain
Shoulder pain
Neck pain
Digestive problems
Sleeping problems
Tinnitus
Headaches
Menstrual pain
Chest pain
Sinus trouble
Allergies
Migraines
Asthma
Tired/Fatigue
Acne or eczema

If you tick any of the above questions, Are you suffering from either of the following? If so, please tick

Stressed
Hypertension High blood Sugar
Pinched Nerves
Structural Misalignment
High cholesterol
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