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Exercise Contraindications

Please fill out this form before testing. If you have any specific questions regarding the form or content within, please contact us.

  • Please use the drop-down menu to select which test you will be using.
  • This questionnaire has been designed by the American College of Sports Medicine (ACSM) to identify individuals for whom exercise testing is contraindicated. Please indicate if any of the following conditions apply.
  • If you have any additional information that was not covered within the questionnaire, please let us know here.

  • If you answer yes to any questions, exercise testing should not be performed without a physician’s approval.

    If you answer no to all questions, there is still no guarantee that exercise testing is risk-free, and you must evaluate for yourself whether you wish to engage in testing.

    By submitting this form, I attest that I have read this questionnaire and, within my knowledge, the answers are true and correct. I understand that it does not provide a medical assessment in lieu of a physical examination by a physician.