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HISTORY You have had: You experience chest discomfort with exertion a heart attack You experience unreasonable breathlessness heart surgery You experience dizziness, fainting, blackouts cardiac catheterization You take heart medications coronary angioplasty (PTCA) pacemaker/implantable cardiac Other Health Issues Family History Have any of your first-degree relatives (parent, sibling, or child) experienced the following conditions? AHA/ACSM Health/Fitness Facility Participation Screening Questionnaire Assess your health status by marking all true statements. Please ask us if you have any questions. PERSONAL … Your responses will be … Acsm Medical History Questionnaire AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire Assess your health needs by marking all true statements. Your responses will be treated in a confidential manner. 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Prior to the testing, players completed a written questionnaire addressing personal and family medical history, issues specific to the female athlete such as menstrual and diet history, and any personal fitness/health goals (Figure 1).The health questionnaire was modeled after one developed by the University of Texas Fitness Institute. Health Screening Amp Risk Stratification RONJONES ORG. Download Free Acsm Medical History Questionnaire & HEALTH HISTORY QUESTIONNAIRE UPANDRUNNING INTEGRATED SPORTS MEDICAL CENTER This form includes several questions regarding your physical health – please answer every question as accurately as possible. ExRx Net Modified ACSM Risk Classification Calculator. Your responses will be treated in a confidential manner. Your responses will be treated in a confidential manner. Appendix D - ACSM Risk Stratification Screening Questionnaire Assess your health by marking all true statements. 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