​Pre-Participation Questionnaire for:

​Medical Clearance

​Answer the following question to determine your need for Medical Clearance.

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​Question 3:
​​PHYSICAL ACTIVITY

3: Which of the following describes your daily pattern of physical activity?
​

• ​Active = At least 15 minutes of light to moderate physical activity per day.

          Example: Fully self-care in the activities of daily living: walking, dressing, cleaning, lifting, stair climbing.​​​ 

• ​Inactive = Less than 15 minutes of light to moderate physical activity per day.

          Example: Limited self-care, often need assistance walking and in other activities of daily living.

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ACTIVE

INACTIVE