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INDOMITABLE Health Waiver

Please fill out the following form 

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had a chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem ( for example back, knee or hip) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Do you know of any other reason why you should not take part in physical activity?

If you answered YES to one or more questions:

 

You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

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If you answered NO to ALL of the questions:

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It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels.

Additional Information
How often do you experience breathlessness while doing daily activities?

Tell me in more detail about your physical recovery from covid-19 and how you are currently managing fatigue

Tell me in more detail how you motivate yourself to be physically active throughout chronic illness flare ups, and how I can assist in providing motivation in a beneficial way

Let's talk about your mental health; any and all information that you want to and are willing to share with me - establishing boundaries and any triggers I can avoid

Thanks for submitting!

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