Online health questionnaire Name Email Message Mobile Emergency Contact Name Emergency Contact Number Do you have a heart condition and have you been advised to undertake medically supervised activity only? Do you experience chest pain brought on by physical activity? Do you tend to lose consciousness or fall over because of dizziness? Do you have a bone or joint problem? Do you have high blood pressure or angina? Do you have glaucoma or detached retina? Are you currently, or have you been pregnant within the last six months? Do you have any other health condition that may be relevant? Please provide details below Submit
