Please answer all questions (putting "No" where relevant and adding detail for "Yes"es), select the tick box at the bottom for T&Cs and click 'Enter'.

    1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

    2. Do you feel pain in your chest when you do physical activity? *

    3. In the past month, have you had chest pain when you were not doing physical activity? *

    4. Do you lose your balance because of dizziness or do you ever lose consciousness? *

    5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

    6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *

    7. Do you know of any other reason why you should not do physical activity? *

    8. Is there anything you feel we should know? *

    Emergency contact name and number *

    I accept the T&Cs shown at www.myrise.co.uk/terms
    Yes

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