MEDICAL Checklist The aim of this checklist is to identify those individuals with a known disease, or signs/symptoms of disease, who may be at higher risk of an adverse event during physical activity/exercise.
This checklist is self-administered and self-evaluated. You must answer all questions 1–8.
1. Have you ever suffered or been told by a doctor that you have suffered a stroke?* 2. Has your doctor ever told you that you have a heart condition?* 3. Do you ever experience unexplained pains in your chest at rest or during physical activity?* 4. Do you ever feel faint or have dizzy spells during physical activity that causes a loss of balance?* 5. Have you had an asthma attack requiring medical attention at any time over the last 12 months?* 6. If you have diabetes (T1/T2), have you had trouble controlling your blood glucose in the last 3 months?* 7. Do you have any diagnosed muscle, bone, joint problems that you have been told could be made worse by participating in physical activity/exercise?* 8. Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise? If YES , please provide additional information below.* Any additional comments or relevant information:
IF YOU ANSWERED "YES" to any of the questions 1–8 above, please consult a GP or appropriate Health Professional to seek clearance/approval to undertake physical activity in our Facility, OR by agreeing to the terms in this questionnaire, you clear yourself of the above medical conditions and are well enough to train at Vale Tudo Training. If a future change in your health, medical or physical capability would lead you to respond "Yes" to any of the questions 1–8 above, please consult your GP or Health Professional before undertaking further physical activity at Vale Tudo Training.
