Answer each question by printing the necessary information. Your answers will be kept confidential.


Have you had any past or current musculoskeletal conditions you have incurred such as muscle pulls, sprains, fractures, surgery, back pain, or general discomfort in the following areas:

If you answered YES to one or more to the Personal Health and Fitness Medical History questionnaire:
Talk with your doctor or in person BEFORE you start becoming much more physically active or Before you have a fitness program.

Tell you doctor about the Miracle Fitness (Fernando Lee) Questionnaire and which questions you answered YES.
• You may be able to do the activity you want – as long as you start slowly and build up gradually
• Or, you may need to restrict your activities to those, which are safe for you.
• Talk with your doctor about the kinds of activities you wish to participate in and follow his/ her advice.
Delay becoming much more physically active:
• If you are feeling unwell because of temporary illness such as cold or fever – wait until you feel better.
• If you are or may be pregnant – talk to your doctor before you start becoming more active.

Please note: If your health changes so that you then answer YES to any of the above questions, before exercising tell your PERSONAL TRAINER. Ask whether you should change your physical activity plan.

Miracle Fitness Health Questionnaire & Terms and Conditions (Informed Consent – Liability Waiver)

Although the Miracle Fitness Health History Questionnaire is designed to assist MIRACLE FITNESS (Fernando Lee) when advising on individual exercise needs, participants are reminded that MIRACLE FITNESS (Fernando Lee) cannot be held responsible for the health of individual participants and that it is the responsibility of all participants to consult with their physician prior to commencing any exercise programme.

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