Beat your PBs with Donut Barbell

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Has your doctor ever said that you have a heart condition and that you should only do physical activity once the doctor has given you permission? *

Yes

No

Do you feel any pain or discomfort in the chest when you partake in any form of physical activity? *

Yes

No

In the past month, have you had chest pain when not doing physical activity? *

Yes

No

Do you ever feel dizzy whilst at the same time also losing your balance? *

Yes

No

Do you have any bone or joint problems (for example; back, knee or hip) that could be made worse or aggravated by a change/increase in physical activity? *

Yes

No

Are you currently taking any prescribed medication for blood pressure or heart condition? *

Yes

No

Is there any other reason why you cannot perform physical activity? *

Yes

No

I agree to the terms and conditions

I agree