Pre-Exercise Screening

Aim: To identify individuals with known disease, and/or signs or symptoms of disease, who may be at a higher risk of an adverse event due to exercise. This assists our Exercise Physiologists to keep you safe and promote awareness when performing exercise testing and programming. 

General Information

Emergency Contact Information

Health Information

Current Exercise/Physical Activity

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

Consent

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The screening system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by Healthy Lifestyles Australia, Exercise & Sport Science Australia, Fitness Australia, Sports Medicine Australia or Exercise is Medicine for any loss, damage, or injury that may arise from any person acting on any statement or information contained in this system.

I understand this form will be used by the Healthy Lifestyles Australia Exercise Physiologist to assess my suitability for participation in exercise, exercise testing, group program or fitness challenge. A face to face or phone consultation may be required prior to participation to ensure your safety, if 1 or more of the initial 6 questions of this form are ticked yes (you will be made aware if this is required).