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Please read the following questions carefully and answer each one honestly:

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? YES / NO

2. Do you feel pain in your chest when you do physical activity? YES / NO

3. Have you ever been told that you have high blood pressure? YES / NO

4. Have you ever had chest pain when you were not doing physical activity? YES / NO

5. Do you ever feel faint or have spells of dizziness? YES / NO

6. Do you have a joint problem that could be made worse by exercise? YES / NO

7. Do you know any other reason that you should not take part in physical activity? YES / NO

If you have answered YES to one or more questions, consult your doctor for advice before becoming more physically active. If you have answered NO to all questions, you can be reasonably sure that you can start to become more physically active and take part in a suitable exercise programme. Postpone classes if you feel unwell, or have a temporary illness. By booking a class you agree to undertake Pole Fitness classes at your own risk

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