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Additional Info

  







Health Details


  

  

  

  

  

  

  


Risk Identification


  
2. Please identify any family history of heart disease (e.g. stroke, heart attack)







  

4. Describe your current physical activity/exercise levels:






5. Please state your



  

  

  
≥ 2 RISK FACTORS – MODERATE RISK CLIENTS

< 2 RISK FACTORS – LOW RISK CLIENTS


Further Health Details

  


  


  


  


Do you have any pain or injuries in the following areas:

     


  


     


     


     


     


     



Girth Measurements (cm)




Blood Pressure






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