Health History Questionnaire (HHQ)

Health History Questionnaire (HHQ)
Please complete as thoroughly as possible. We strongly encourage completing the form in the club so staff are available for questions. Depending on your risk factors checked on this questionnaire, guidelines from the American Heart Association and the American College of Sports Medicine may recommend physician clearance prior to exercise. If a physicians clearance is required, Four Seasons will contact your health care provider before prescribing an individualized exercise program. Please feel free to use the facility on your own.

Personal Information

Physician Information

Section 1

Please check all that apply to you.

Section 2

Please check all that apply to you.

Section 3

Please check all that apply to you.

Section 4

Please check all that apply to your personal goals

Section 5

Please enter 'N/A' if this does not apply

Section 6

feet
inches
pounds
Record numbers below if known:
Sending