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Client Intake Form
Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke?
Have you ever experienced unexplained pains or discomfort in your chest at rest or during physical activity/exercise?
Do you ever feel faint, dizzy, or lose balance during physical activity/exercise?
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
If you have diabetes (type 1 or 2), have you had trouble controlling your blood sugar (glucose) in the last 3 months?
Do you have any other serious health conditions that may require special consideration for you to exercise?

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