Participation Questionnaire

Your Health Matters

Health Questionnaire (Par-Q)

 

The health questionnaire helps us to understand your health and medical history and needs. It is important to ensure that the classes you attend are safe and appropriate. Please complete your answers to the best of your knowledge. Cove Mind & Body may need to contact you about your answers, so please include a reliable contact number.

Your answers will be available to Cove Mind & Body class instructors. We will never share your information outside of our staff without your permission. You can read our full privacy policy by copying and pasting the following URL into your browser:  https://covecornwall.co.uk/policies/

 

 

Name
Name
First Name
Last Name
Has your doctor ever said that you have a heart condition and that you should only do physical activity when recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had 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 that could be made worse by a change in your physical activity?
Is your doctor currently prescribing you drugs (for example water pills) for your blood pressure or heart?
Are you pregnant or have you given birth within the last 6 months?

Follow Us
Address

Cove Mind & Body

Fore Street

East Looe

Cornwall

PL13 1AD

Email

hello@covecornwall.co.uk