VO2 MAX TESTING MEDICAL QUESTIONAIRRE Name * First Name Last Name Phone (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Age * DOB * MM DD YYYY Sex * Male Female Height * ft/in Weight * in lbs Emergency Contact * Name and phone # Check if you have ever been diagnosed with any of these conditions: * Heart disease Stroke or TIA High Blood Pressure Anemia Concussion Asthma Diabetes Eating Disorder Thyroid Problems Cancer Allergies Rheumatoid Arthriits Osteoarthritis Depression Other None Please explain here with the year you were diagnosed * Medications you currently take (please include over-the-counter medications) * Describe any running injuries, past or present. Have they been resolved completely? * My experience as a runner is... * I'm just getting interested in running Less than 6 months 6 months to 1 year 1-3 years 3-5 years More than 5 years Thank you!
