Physical Activity Readiness Questionnaire

Your Details

Medical Information
Please answer all the following questions. If you answer ‘yes’ to any of them, you may need your doctor’s consent before you participate in Nordic Walking.
1. Has a doctor ever said that you have a heart condition or high blood pressure?
2. Do you have chest pain at rest or brought on by physical activity?
3. Do you lose balance because of dizziness or have you lost consciousness in the last 12 months?
4. Do you have a bone or joint problem that could be made worse by physical activity?
5. Are you currently taking medication for a condition that you need to carry with you on a walk?

6. Has your doctor ever said that you should only do medically supervised activity?
7. Have you been diagnosed with a long term medical condition or allergy that might affect your ability to exercise?

Physical Condition

Emergency Contact

Photography
Nordic4 would like to sensitively use personal images by photography or video recording for marketing purposes including sharing across social media channels. In the case of video recording, further permission will be asked for at the time.

Data Protection
Your information will be stored securely by the instructor and will not be given to anyone else. You must notify your instructor of any changes in your personal data. Your email address or phone number will be used to notify you about Nordic Walking important changes to sessions, for example, due to weather conditions. This is in accordance with our Privacy Policy.

Please tell us how you heard about Nordic Walking