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Member Details
Additional Member Info
Next of Kin
Your Healthinfo Details
Question Acknowledge Further Details Supplied
Have you had any unexplained chest pains in the last 6 months? / Het u enige ongemaklike pyn in u bors in die laaste 6 maande?
Have you been under any treatment in the last 6 months? / Is u in die laaste 6 maande onder enige behandeling?
Do you have an elevated cholesterol level? / Het u 'n verhoogde cholesterol vlak?
Have you ever had a stroke/ heart attack/ angina? / Is u al gediagnoseer met 'n beroerte/ hart aanval of angina?
Are you currently taking any medication? / Neem u tans enige medikasie?
Have you had any surgery in the last 24 months? / Het u enige operasies en/ of prosedures ondergaan in die laaste 24 maande?
Have you ever had a hernia? / Het u al ooit 'n hernia gehad/ het tans 'n hernia?
Do you have arthritis? / Lei u aan arthritis?
Are you diabetic / Lei u aan diabetes?
Are you pregnant? / Is u swanger?
Do you smoke any tobacco products? / Rook u enige tabak-produkte?
Are you a sedentary male over 45 years or a female over 50 years? / Is u 'n sedentere man oor 45 jaar of vrou oor 50 jaar oud?
Has any medical practitioner ever warned you against exercise? / Het 'n mediese praktisyn u al ooit gewaarsku teen oefening?
Do you suffer from any joint/ muscle/ ligament pain? / Lei u aan enige gewrig/ spier/ ligament pyn?
Do you suffer from hypoglaecemia? / Lei u aan lae glukose vlakke (hypoglaecemia)?
Do you ever feel faint or suffer from dizzy spells? / Voel u ooit lighoofdig?
Do you suffer from respiratory problems (asthma)? / Lei u aan enige respiratoriese probleme (asthma)?
Is there anything that could be deemed relevant in your participation in an activity program that you have not told us yet?/ Is daar enige iets relevant in u deelname aan fisiese aktiwiteite waarvan u ons nog nie ingelig het nie?
Final Confirmation