SCULPT PRE-TRAINING QUESTIONNAIRE:

PERSONAL DATA:

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SCULPT PRE-TRAINING QUESTIONNAIRE

To register, please take the time to fill out the information below.

1. GENERAL MEDICAL INFORMATION:

1.1 Do you have any known illnesses or medical conditions at present or any under investigation?  If yes, please provide details including any current treatment you are undertaking

1.2 Are you on any medication or undertaking any therapy for a diagnosed condition?

1.3 Have you ever been admitted to or received treatment from hospital, for any reason in the last 5 years?    If yes, please provide dates, hospital details and reasons:

1.4 Have you been absent from work due to illness in the last two years If so, why and how for how long?

1.5 Do you have any recurring medical, surgical or emotional problems? If yes, please provide details below even if you currently aren’t suffering from them.

1.6 Are you a registered disabled person? If so, please give details of the nature of your disability.

1.7 Do you smoke? If so, please provide details:

1.8 Any additional information:

CARDIOVASCULAR SYSTEM

(Do you currently have or have had in the past 5 years.)

2.1 Heart disease or blood pressure problems – low and high?

2.2 Shortness of breath/chest condition including pain? 

2.3 Metabolic issues - Type 1 or Type 2 Diabetes. 

2.4 Have you been diagnosed with Anemia?

2.5 If answered yes to any     

       questions, are these

       impacted / affected by

       exercise or impair your

       ability to exercise?

RESPIRATORY SYSTEM:

(Do you currently have or have had in the past 5 years)

3.1 Suffered from shortness of breath when not exercising

3.2 Lung conditions including cystic fibrosis?

3.3 Asthma – if yes what medications are you taking?

3.4 If answered yes to any 

      questions, are these

      impacted / affected by

      exercise or impair your

      ability to exercise?

DIGESTIVE SYSTEM:

(Do you currently have or have had in the past 5 years)

4.1 Nausea, indigestion or ulcer?

4.2 Medicated food allergies that have an autoimmune response (IGE)?

4.3 Crohn's disease or Celiac's disease?

4.4 If answered yes to any

       questions, are these

       impacted / affected by

       exercise or impair your

       ability to exercise?

CENTRAL NERVOUS SYSTEM:

(Do you currently have or have had in the past 5 years)

5.1 Suffer from blackouts, fainting or giddiness?

5.2 Light Headedness or dizziness?

5.3 Regular migraines or headaches?

5.4 If answered yes to any

       questions, are these

       impacted / affected by

       exercise or impair your

       ability to exercise?

REPRODUCTIVE / URINARY SYSTEM:

6.1 Are you pregnant or is it possible that you may be pregnant?

6.2 Have you given birth in the past 12 months?

6.3 If yes, are you recovering from a C-Section?

6.4 Are you experiencing any symptoms of Menopause or taking medications for

       Menopause?

6.5 Do you have Polycystic Ovary Syndrome, Endometriosis or any other diagnosed

       medical condition pertaining to your gender?

6.6 Do you have any kidney issues including Chronic Kidney Disease?

6.7 Any bladder issues?

6.8 If answered yes to any

       questions, are these