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MEDICAL FORM

STAGE 1

Has your medical practitioner ever told you that you have a heart condition, or have you ever suffered a stroke? Required
Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise? Required
Do you ever feel faint, dizzy or lose balance during physical activity/exercise? Required
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months? Required
If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months? Required
Do you have any other conditions that may require special consideration for you to exercise? Required

  • If your total is less than 150 minutes per week then light to moderate intensity exercise is recommended. Increase your volume and intensity slowly.  

  • If you total is more than or equal to 150 minutes per week then continue with your current physical activity/exercise intensity levels.

  • It advised that you discuss any progression with MPower Physical Therapy

STAGE 2

AIM: This stage is to be completed to determine appropriate exercise prescription based on established risk factors

Have you been told that you have high blood pressure? Required
If yes, are you taking any medication for this condition?
Have you been told that you have high cholesterol/ blood lipids? Required
If yes, are you taking any medication for this condition?
Have you been told that you have high blood sugar (glucose)? Required
If yes, are you taking any medication for this condition?
Are you currently taking prescribed medication(s) for any condition(s)? These are additional to those already provided. Required
Have you spent time in hospital (including day admission) for any condition/illness/injury during the last 12 months? Required
Are you pregnant or have you given birth within the last 12 months? Required
Do you have any diagnosed muscle, bone, tendon, ligament or joint problems that you have been told could be made worse by participating in exercise? Required

Prior to your first session, please fill out the below form so that we are able create the best possible training plan for you.

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