ACSM HEALTH STATUS QUESTIONNAIRE - YMCA of the Fox Cities 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information at the top of the form, including your name, address, city, state, zip code, date of birth, and daytime phone number.
3. Proceed to the 'WITH DISEASE' section. Carefully read each question and respond with a 'YES' or 'NO'. Ensure you answer all questions accurately for a proper assessment.
4. Next, move to the 'WITH SYMPTOMS' section. Again, answer each question truthfully. If you check more than two symptoms, note that physician approval may be required.
5. In the 'AT RISK' section, indicate any relevant family history or health conditions by marking 'YES' or 'NO'. This helps in assessing your risk level without needing physician approval.
6. Provide additional health conditions that may affect your exercise program in the designated area. The more details you provide here, the better tailored your program can be.
7. Finally, verify that all information is correct and sign at the bottom of the form. Include the date of signing to complete your submission.

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