Health & Lifestyle Questionnaire

Activity History/Goal

Tell us a little about your current exercise or activity.

Health Screening - History

Please provide some general information about your overall health.

Health Screening - Signs and Symptoms

Please provide answers to these questions based on the last 12 months.

Health Information Acknowledgement

I have answered all questions truthfully and to the best of my knowledge. I have not knowingly withheld any information regarding my health. I understand that it is my responsibility to update the Reh-Fit Centre staff about any changes in health status that could affect my ability to safely participate at the Reh-Fit Centre.