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Has your doctor ever said you have a heart condition, and that you should only do physical activity recommended by a doctor?

Do you ever have chest pain while doing physical activity?

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

Do you ever loose balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem (back, knee, hip) that could be made worse by a change in your physical activity?

Is your doctor prescribing drugs for you (blood pressure or heart condition)?

Do you know of any other reason why you should not participate in physical activity?

Have you had surgery in the past two years?

Are you currently taking medications?