5. Do you have a bone or joint problem (for example, back, knee, or hip) that could made worse by change in your physical activity?
- select - Yes No

6. Is your doctor prescribing medication for your blood pressure or heart condition?
- select - Yes No  

7. Do you loose your balance because of dizziness or do you ever lose consciousness?
- select - Yes No

8. Do you know of any other reason why you should not do physical activity?
- select - Yes No

9. What are your goals or reason for wanting to exercise (i.e. loose weight, get fitter, training for event)?

10. How many times a week would you be interested in personal training?
- select - None Once Twice Three Four or More