Retirement Cake Verbage

RISK FACTORS SURVEY-FIRST CONTRIBUTION SMALL HOMAGE

Good evening, here is the bake pan to present the first contribution on our blog. Take this opportunity to say thank you!! Keep contributing, and succeed together a good blog Indoor Cycle.

RISK FACTORS SURVEY INITIAL
SPINNING THE STUDENT

Name: _________________________________________ Date :________



Age :_____ Sex: M / M

Person to contact in case of Emergency
:_____________________________ Name :____________________________________________________ Relationship

Phone (s) of contact: __________________
important Datosmédicos :_________________________________________________ ___________________________________________________________


Currently, are you taking any medication? YES / NO
(If yes specify the medication :_______________________________)


Do you suffer now or have had in the past ...? (Mark X)

or heart problems or hypertension


or chronic illness or a problem with exercise or recommendation
medical
no physical exercise or surgery during the past year
or currently pregnant or in the last 3 months
or respiratory or lung problems
or muscle problems, joint or back pain or
Diabetes and other hormonal disorders, or hypercholesterolemia


Do you smoke? YES / NO if so approx., How many cigarettes per day? _______


Sort your stress level by selecting one of the following options:

-RARELY-NEVER OCCASIONALLY FREQUENTLY-ALWAYS-




Thank you for lacolaboración! This can lead us to make you reach your goals without putting your health at risk.