Health Questionnaire NEW MEMBER QUESTIONNAIRE Your Health & Workout History "*" indicates required fields Your Name* First Last Your Email* Has your doctor ever said you have either of the following:* Heart condition High blood pressure Neither Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?* Yes No I'm not sure Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?*Please answer No if your dizziness was associated with over-breathing (including during vigorous exercise). Yes No I'm not sure Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?* Yes No I'm not sure Please list conditions here:Are you currently taking prescribed medications for a chronic medical condition?* Yes No I'm not sure Please list conditions and medications here:Do you have (or have you had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active?*Please answer No if you had a problem in the past, but it does not limit your current ability to be physically active. Yes No I'm not sure Please list conditions here:Has your doctor ever said that you should only do medically supervised physical activity?* Yes No I'm not sure PhoneThis field is for validation purposes and should be left unchanged.