{"id":288,"date":"2025-07-19T22:35:52","date_gmt":"2025-07-19T22:35:52","guid":{"rendered":"https:\/\/evolvetofitness.com\/?page_id=288"},"modified":"2025-07-19T22:35:52","modified_gmt":"2025-07-19T22:35:52","slug":"par-q","status":"publish","type":"page","link":"https:\/\/evolvetofitness.com\/index.php\/par-q\/","title":{"rendered":"Par-Q +"},"content":{"rendered":"<style id=\"wpforms-css-vars-241-block-6a1b4a6d-8a67-4732-b567-07e0685f21fa\">\n\t\t\t\t#wpforms-241.wpforms-block-6a1b4a6d-8a67-4732-b567-07e0685f21fa {\n\t\t\t\t--wpforms-label-error-color: #edb254;\n--wpforms-page-break-color: #ef8225;\n--wpforms-button-background-color: #111111;\n--wpforms-button-text-color: #edb254;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-6a1b4a6d-8a67-4732-b567-07e0685f21fa wpforms-render-modern\" id=\"wpforms-241\"><form id=\"wpforms-form-241\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"241\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/288\" data-token=\"7670bc08f728fcabb1098b96bed7654b\" data-token-time=\"1777581748\"><div class=\"wpforms-head-container\"><div class=\"wpforms-description\">FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL CONDITION(S)<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"5\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> &#8211; <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 5<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:20%;background-color:#066aab\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-241-field_16-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"16\"><\/div><div id=\"wpforms-241-field_79-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"79\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-241-field_79\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][79][first]\" aria-errormessage=\"wpforms-241-field_79-error\" required><label for=\"wpforms-241-field_79\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-241-field_79-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][79][last]\" aria-errormessage=\"wpforms-241-field_79-last-error\" required><label for=\"wpforms-241-field_79-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-241-field_110-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_110\">Date <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-241-field_110\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][110][date]\" aria-errormessage=\"wpforms-241-field_110-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-241-field_81-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"81\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_81\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-241-field_81\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][81]\" spellcheck=\"false\" aria-errormessage=\"wpforms-241-field_81-error\" required><\/div><div id=\"wpforms-241-field_80-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_80\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-241-field_80\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][80]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-241-field_80-error\" required><\/div><div id=\"wpforms-241-field_96-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"96\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"241\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-241-field_98-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"98\"><h3 id=\"wpforms-241-field_98\" aria-errormessage=\"wpforms-241-field_98-error\" aria-describedby=\"wpforms-241-field_98-description\">The Physical Activity Readiness Questionnaire for Everyone<\/h3><div id=\"wpforms-241-field_98-description\" class=\"wpforms-field-description\">The health benefts of regular physical activity are clear; more people should engage in physical activity every day of the\nweek. Participating in physical activity is very safe for MOST people. This questionnaire will tell you whether it is\nnecessary for you to seek further advice from your doctor OR a qualified exercise professional before becoming more\nphysically active.\n<\/div><\/div><div id=\"wpforms-241-field_97-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"97\"><fieldset><legend class=\"wpforms-field-label\">1) Has your doctor ever said that you have a heart condition OR high blood pressure ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_97\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_97_1\" name=\"wpforms[fields][97]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_97_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_97_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_97_2\" name=\"wpforms[fields][97]\" value=\"No\" aria-errormessage=\"wpforms-241-field_97_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_97_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_99-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"99\"><fieldset><legend class=\"wpforms-field-label\">2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_99\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_99_1\" name=\"wpforms[fields][99]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_99_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_99_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_99_2\" name=\"wpforms[fields][99]\" value=\"No\" aria-errormessage=\"wpforms-241-field_99_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_99_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_100-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"100\"><fieldset><legend class=\"wpforms-field-label\">3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_100\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_100_1\" name=\"wpforms[fields][100]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_100_1-error\" aria-describedby=\"wpforms-241-field_100-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_100_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_100_2\" name=\"wpforms[fields][100]\" value=\"No\" aria-errormessage=\"wpforms-241-field_100_2-error\" aria-describedby=\"wpforms-241-field_100-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_100_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_100-description\" class=\"wpforms-field-description\">Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_101-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"101\"><fieldset><legend class=\"wpforms-field-label\">4) Have you ever been diagnosed with another chronic medical condition <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_101\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_101_1\" name=\"wpforms[fields][101]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_101_1-error\" aria-describedby=\"wpforms-241-field_101-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_101_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_101_2\" name=\"wpforms[fields][101]\" value=\"No\" aria-errormessage=\"wpforms-241-field_101_2-error\" aria-describedby=\"wpforms-241-field_101-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_101_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_101-description\" class=\"wpforms-field-description\">Other than heart disease or high\nblood pressure<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_103-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"103\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_103\">PLEASE LIST CONDITION(S) HERE: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-241-field_103\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][103]\" aria-errormessage=\"wpforms-241-field_103-error\" required><\/textarea><\/div><div id=\"wpforms-241-field_102-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"102\"><fieldset><legend class=\"wpforms-field-label\">5) Are you currently taking prescribed medications for a chronic medical condition? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_102\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_102_1\" name=\"wpforms[fields][102]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_102_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_102_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_102_2\" name=\"wpforms[fields][102]\" value=\"No\" aria-errormessage=\"wpforms-241-field_102_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_102_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_105-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"105\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_105\">PLEASE LIST CONDITION(S) AND MEDICATIONS HERE <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-241-field_105\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][105]\" aria-errormessage=\"wpforms-241-field_105-error\" required><\/textarea><\/div><div id=\"wpforms-241-field_106-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"106\"><fieldset><legend class=\"wpforms-field-label\">6) Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_106\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_106_1\" name=\"wpforms[fields][106]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_106_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_106_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_106_2\" name=\"wpforms[fields][106]\" value=\"No\" aria-errormessage=\"wpforms-241-field_106_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_106_2\">No<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-241-field_5-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"5\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-241-field_5\" >confusion, medication? HERE:<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-241-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-241-field_104-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"104\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_104\">PLEASE LIST CONDITION(S) HERE: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-241-field_104\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][104]\" aria-errormessage=\"wpforms-241-field_104-error\" required><\/textarea><\/div><div id=\"wpforms-241-field_107-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"107\"><fieldset><legend class=\"wpforms-field-label\">7) Has your doctor ever said that you should only do medically supervised physical activity? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_107\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_107_1\" name=\"wpforms[fields][107]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_107_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_107_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_107_2\" name=\"wpforms[fields][107]\" value=\"No\" aria-errormessage=\"wpforms-241-field_107_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_107_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_108-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"108\"><div id=\"wpforms-241-field_108\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-241-field_108-error\"><p>If you answered NO to all of the questions above, you are cleared for physical activity. Please sign the<br \/>\nPARTICIPANT DECLARATION. You do not need to complete Pages 3 and 4.<br \/>\nStart becoming much more physically active \u2013 start slowly and build up gradually.<br \/>\nFollow International Physical Activity Guidelines for your age (www.who.int\/dietphysicalactivity\/en\/).<br \/>\nYou may take part in a health and ftness appraisal.<br \/>\nIf you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal efort exercise,<br \/>\nconsult a qualifed exercise professional before engaging in this intensity of exercise.<br \/>\nIf you have any further questions, contact a qualifed exercise professional.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-241-field_128-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"128\"><h3 id=\"wpforms-241-field_128\" aria-errormessage=\"wpforms-241-field_128-error\">PARTICIPANT DECLARATION<\/h3><\/div><div id=\"wpforms-241-field_129-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"129\"><div id=\"wpforms-241-field_129\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-241-field_129-error\"><p>If you are less than the legal age required for consent or require the assent<br \/>\nof a care provider, your parent, guardian or care provider must also sign this form.<br \/>\nI, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical<br \/>\nactivity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also<br \/>\nacknowledge that the community\/ftness centre may retain a copy of this form for records. In these instances, it will maintain the<br \/>\nconfdentiality of the same, complying with applicable law.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-241-field_111-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"111\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_111\">Signature <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-241-field_111\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][111]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-241-field_111-error\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-241-field_111-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-241-field_114-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"114\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_114\">Guardian\/Care Provider Signature<\/label><input type=\"text\" id=\"wpforms-241-field_114\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][114]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-241-field_114-error\" ><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-241-field_114-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-241-field_115-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"115\"><div id=\"wpforms-241-field_115\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-241-field_115-error\"><h4>If you answered YES to one or more of the questions above, COMPLETE PAGES 3 AND 4.<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-241-field_116-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"116\"><div id=\"wpforms-241-field_116\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-241-field_116-error\"><p>Delay becoming more active if:<br \/>\nYou have a temporary illness such as a cold or fever; it is best to wait until you feel better.<br \/>\nYou are pregnant &#8211; talk to your health care practitioner, your physician, a qualifed exercise professional,<br \/>\nand\/or complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active.<br \/>\nYour health changes &#8211; answer the questions on Pages 2 and 3 of this document<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-241-field_78-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"78\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"241\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-241-field_1-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">1. Do you have Arthritis, Osteoporosis, or Back Problems?<\/legend><ul id=\"wpforms-241-field_1\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_1_1\" name=\"wpforms[fields][1]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_1_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_1_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_1_2\" name=\"wpforms[fields][1]\" value=\"No\" aria-errormessage=\"wpforms-241-field_1_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_1_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_2-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"2\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">1a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_2\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_2_1\" name=\"wpforms[fields][2]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_2_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_2_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_2_2\" name=\"wpforms[fields][2]\" value=\"No\" aria-errormessage=\"wpforms-241-field_2_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_2_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_3-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"3\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">1b. Do you have joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer, displaced vertebra <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_3\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_3_1\" name=\"wpforms[fields][3]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_3_1-error\" aria-describedby=\"wpforms-241-field_3-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_3_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_3_2\" name=\"wpforms[fields][3]\" value=\"No\" aria-errormessage=\"wpforms-241-field_3_2-error\" aria-describedby=\"wpforms-241-field_3-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_3_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_3-description\" class=\"wpforms-field-description\">e.g., spondylolisthesis), and\/or spondylolysis\/pars defect (a crack in the bony ring on the back of the spinal column<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_4-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"4\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">1c. Have you had steroid injections or taken steroid tablets regularly for more than 3 months? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_4_1\" name=\"wpforms[fields][4]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_4_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_4_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_4_2\" name=\"wpforms[fields][4]\" value=\"No\" aria-errormessage=\"wpforms-241-field_4_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_4_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_6-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">2. Do you currently have Cancer of any kind?<\/legend><ul id=\"wpforms-241-field_6\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_6_1\" name=\"wpforms[fields][6]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_6_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_6_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_6_2\" name=\"wpforms[fields][6]\" value=\"No\" aria-errormessage=\"wpforms-241-field_6_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_6_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_8-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"8\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">2a. Does your cancer diagnosis include any of the following types: lung\/bronchogenic, multiple myeloma (cancer of plasma cells), head, and\/or neck? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_8_1\" name=\"wpforms[fields][8]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_8_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_8_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_8_2\" name=\"wpforms[fields][8]\" value=\"No\" aria-errormessage=\"wpforms-241-field_8_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_8_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_10-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"10\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">2b. Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_10\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_10_1\" name=\"wpforms[fields][10]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_10_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_10_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_10_2\" name=\"wpforms[fields][10]\" value=\"No\" aria-errormessage=\"wpforms-241-field_10_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_10_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_82-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"82\"><fieldset><legend class=\"wpforms-field-label\">3. Do you have a Heart or Cardiovascular Condition? This includes Coronary Artery Disease, Heart Failure, Diagnosed Abnormality of Heart Rhythm<\/legend><ul id=\"wpforms-241-field_82\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_82_1\" name=\"wpforms[fields][82]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_82_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_82_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_82_2\" name=\"wpforms[fields][82]\" value=\"No\" aria-errormessage=\"wpforms-241-field_82_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_82_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_83-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"83\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">3a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_83\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_83_1\" name=\"wpforms[fields][83]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_83_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_83_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_83_2\" name=\"wpforms[fields][83]\" value=\"No\" aria-errormessage=\"wpforms-241-field_83_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_83_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_84-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"84\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">3b. Do you have an irregular heart beat that requires medical management? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_84\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_84_1\" name=\"wpforms[fields][84]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_84_1-error\" aria-describedby=\"wpforms-241-field_84-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_84_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_84_2\" name=\"wpforms[fields][84]\" value=\"No\" aria-errormessage=\"wpforms-241-field_84_2-error\" aria-describedby=\"wpforms-241-field_84-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_84_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_84-description\" class=\"wpforms-field-description\">e.g., atrial fibrillation, premature ventricular\ncontraction<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_85-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"85\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">3c. Do you have chronic heart failure? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_85\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_85_1\" name=\"wpforms[fields][85]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_85_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_85_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_85_2\" name=\"wpforms[fields][85]\" value=\"No\" aria-errormessage=\"wpforms-241-field_85_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_85_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_86-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"86\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">3d. Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical activity in the last 2 months? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_86\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_86_1\" name=\"wpforms[fields][86]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_86_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_86_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_86_2\" name=\"wpforms[fields][86]\" value=\"No\" aria-errormessage=\"wpforms-241-field_86_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_86_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_87-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"87\"><fieldset><legend class=\"wpforms-field-label\">4. Do you have High Blood Pressure?<\/legend><ul id=\"wpforms-241-field_87\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_87_1\" name=\"wpforms[fields][87]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_87_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_87_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_87_2\" name=\"wpforms[fields][87]\" value=\"No\" aria-errormessage=\"wpforms-241-field_87_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_87_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_88-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"88\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">4a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_88\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_88_1\" name=\"wpforms[fields][88]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_88_1-error\" aria-describedby=\"wpforms-241-field_88-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_88_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_88_2\" name=\"wpforms[fields][88]\" value=\"No\" aria-errormessage=\"wpforms-241-field_88_2-error\" aria-describedby=\"wpforms-241-field_88-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_88_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_88-description\" class=\"wpforms-field-description\">Answer NO if\nyou are not currently taking medications or other treatments<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_89-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"89\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">4b. Do you have a resting blood pressure equal to or greater than 160\/90 mmHg with or without medication? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_89\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_89_1\" name=\"wpforms[fields][89]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_89_1-error\" aria-describedby=\"wpforms-241-field_89-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_89_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_89_2\" name=\"wpforms[fields][89]\" value=\"No\" aria-errormessage=\"wpforms-241-field_89_2-error\" aria-describedby=\"wpforms-241-field_89-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_89_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_89-description\" class=\"wpforms-field-description\">Answer YES if\nyou do not know your resting blood pressure<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_90-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"90\"><fieldset><legend class=\"wpforms-field-label\">5. Do you have any Metabolic Conditions? This includes Type 1 Diabetes, Type 2 Diabetes, Pre-Diabetes<\/legend><ul id=\"wpforms-241-field_90\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_90_1\" name=\"wpforms[fields][90]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_90_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_90_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_90_2\" name=\"wpforms[fields][90]\" value=\"No\" aria-errormessage=\"wpforms-241-field_90_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_90_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_91-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"91\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">5a. Do you often have difficulty controlling your blood sugar levels with foods, medications, or other physician- prescribed therapies? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_91\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_91_1\" name=\"wpforms[fields][91]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_91_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_91_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_91_2\" name=\"wpforms[fields][91]\" value=\"No\" aria-errormessage=\"wpforms-241-field_91_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_91_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_92-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"92\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">5b. Do you often suffer from signs and symptoms of low blood sugar (hypoglycemia) following exercise and\/or during activities of daily living? Signs of hypoglycemia may include shakiness, nervousness, unusual irritability, abnormal sweating, dizziness or light-headedness, mental confusion, difficulty speaking, weakness, or sleepiness. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_92\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_92_1\" name=\"wpforms[fields][92]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_92_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_92_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_92_2\" name=\"wpforms[fields][92]\" value=\"No\" aria-errormessage=\"wpforms-241-field_92_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_92_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_93-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"93\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">5c. Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and\/or complications affecting your eyes, kidneys, OR the sensation in your toes and feet? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_93\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_93_1\" name=\"wpforms[fields][93]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_93_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_93_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_93_2\" name=\"wpforms[fields][93]\" value=\"No\" aria-errormessage=\"wpforms-241-field_93_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_93_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_94-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"94\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">5d. Do you have other metabolic conditions <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_94\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_94_1\" name=\"wpforms[fields][94]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_94_1-error\" aria-describedby=\"wpforms-241-field_94-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_94_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_94_2\" name=\"wpforms[fields][94]\" value=\"No\" aria-errormessage=\"wpforms-241-field_94_2-error\" aria-describedby=\"wpforms-241-field_94-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_94_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_94-description\" class=\"wpforms-field-description\">Such as current pregnancy-related diabetes, chronic kidney disease, or liver\nproblems<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_95-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"95\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">5e. Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_95\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_95_1\" name=\"wpforms[fields][95]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_95_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_95_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_95_2\" name=\"wpforms[fields][95]\" value=\"No\" aria-errormessage=\"wpforms-241-field_95_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_95_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_15-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"15\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"241\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-241-field_18-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">6. Do you have any Mental Health Problems or Learning Difficulties? This includes Alzheimer\u2019s, Dementia, Depression, Anxiety Disorder, Eating Disorder, Psychotic Disorder, Intellectual Disability, Down Syndrome<\/legend><ul id=\"wpforms-241-field_18\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_18_1\" name=\"wpforms[fields][18]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_18_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_18_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_18_2\" name=\"wpforms[fields][18]\" value=\"No\" aria-errormessage=\"wpforms-241-field_18_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_18_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_19-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"19\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">6a. Do you have diffculty controlling your condition with medications or other physician-prescribed therapies? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_19_1\" name=\"wpforms[fields][19]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_19_1-error\" aria-describedby=\"wpforms-241-field_19-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_19_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_19_2\" name=\"wpforms[fields][19]\" value=\"No\" aria-errormessage=\"wpforms-241-field_19_2-error\" aria-describedby=\"wpforms-241-field_19-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_19_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_19-description\" class=\"wpforms-field-description\">Answer NO if you are not currently taking medications or other treatments<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_117-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"117\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">6b. Do you have Down Syndrome AND back problems affecting nerves or muscles? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_117\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_117_1\" name=\"wpforms[fields][117]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_117_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_117_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_117_2\" name=\"wpforms[fields][117]\" value=\"No\" aria-errormessage=\"wpforms-241-field_117_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_117_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_20-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">7. Do you have a Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma, Pulmonary High Blood Pressure<\/legend><ul id=\"wpforms-241-field_20\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_20_1\" name=\"wpforms[fields][20]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_20_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_20_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_20_2\" name=\"wpforms[fields][20]\" value=\"No\" aria-errormessage=\"wpforms-241-field_20_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_20_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_21-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"21\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">7a. Do you have diffculty controlling your condition with medications or other physician-prescribed therapies? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_21_1\" name=\"wpforms[fields][21]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_21_1-error\" aria-describedby=\"wpforms-241-field_21-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_21_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_21_2\" name=\"wpforms[fields][21]\" value=\"No\" aria-errormessage=\"wpforms-241-field_21_2-error\" aria-describedby=\"wpforms-241-field_21-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_21_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_21-description\" class=\"wpforms-field-description\">Answer NO if you are not currently taking medications or other treatments<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_118-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"118\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">7b. Has your doctor ever said your blood oxygen level is low at rest or during exercise and\/or that you require supplemental oxygen therapy? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_118\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_118_1\" name=\"wpforms[fields][118]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_118_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_118_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_118_2\" name=\"wpforms[fields][118]\" value=\"No\" aria-errormessage=\"wpforms-241-field_118_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_118_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_119-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"119\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">7c. If asthmatic, do you currently have symptoms of chest tightness, wheezing, labored breathing, consistent cough (more than 2 days\/week), or have you used your rescue medication more than twice in the last week? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_119\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_119_1\" name=\"wpforms[fields][119]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_119_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_119_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_119_2\" name=\"wpforms[fields][119]\" value=\"No\" aria-errormessage=\"wpforms-241-field_119_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_119_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_120-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"120\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">7d. Has your doctor ever said you have high blood pressure in the blood vessels of your lungs? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_120\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_120_1\" name=\"wpforms[fields][120]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_120_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_120_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_120_2\" name=\"wpforms[fields][120]\" value=\"No\" aria-errormessage=\"wpforms-241-field_120_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_120_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_23-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">8. Do you have a Spinal Cord Injury? This includes Tetraplegia and Paraplegia<\/legend><ul id=\"wpforms-241-field_23\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_23_1\" name=\"wpforms[fields][23]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_23_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_23_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_23_2\" name=\"wpforms[fields][23]\" value=\"No\" aria-errormessage=\"wpforms-241-field_23_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_23_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_25-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"25\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">8a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_25\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_25_1\" name=\"wpforms[fields][25]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_25_1-error\" aria-describedby=\"wpforms-241-field_25-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_25_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_25_2\" name=\"wpforms[fields][25]\" value=\"No\" aria-errormessage=\"wpforms-241-field_25_2-error\" aria-describedby=\"wpforms-241-field_25-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_25_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_25-description\" class=\"wpforms-field-description\">Answer NO if you\nare not currently taking medications or other treatments<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_121-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"121\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">8b. Do you commonly exhibit low resting blood pressure significant enough to cause dizziness, light-headedness, and\/or fainting? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_121\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_121_1\" name=\"wpforms[fields][121]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_121_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_121_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_121_2\" name=\"wpforms[fields][121]\" value=\"No\" aria-errormessage=\"wpforms-241-field_121_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_121_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_122-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"122\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">8c. Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic Dysreflexia)? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_122\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_122_1\" name=\"wpforms[fields][122]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_122_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_122_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_122_2\" name=\"wpforms[fields][122]\" value=\"No\" aria-errormessage=\"wpforms-241-field_122_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_122_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_26-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"26\"><fieldset><legend class=\"wpforms-field-label\">9. Have you had a Stroke? This includes Transient Ischemic Attack (TIA) or Cerebrovascular Event<\/legend><ul id=\"wpforms-241-field_26\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_26_1\" name=\"wpforms[fields][26]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_26_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_26_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_26_2\" name=\"wpforms[fields][26]\" value=\"No\" aria-errormessage=\"wpforms-241-field_26_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_26_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_27-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"27\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">9a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_27\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_27_1\" name=\"wpforms[fields][27]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_27_1-error\" aria-describedby=\"wpforms-241-field_27-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_27_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_27_2\" name=\"wpforms[fields][27]\" value=\"No\" aria-errormessage=\"wpforms-241-field_27_2-error\" aria-describedby=\"wpforms-241-field_27-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_27_2\">No<\/label><\/li><\/ul><div id=\"wpforms-241-field_27-description\" class=\"wpforms-field-description\">Answer NO if you\nare not currently taking medications or other treatments<\/div><\/fieldset><\/div><div id=\"wpforms-241-field_123-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"123\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">9b. Do you have any impairment in walking or mobility? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_123\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_123_1\" name=\"wpforms[fields][123]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_123_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_123_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_123_2\" name=\"wpforms[fields][123]\" value=\"No\" aria-errormessage=\"wpforms-241-field_123_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_123_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_124-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"124\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">9c. Have you experienced a stroke or impairment in nerves or muscles in the past 6 months? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_124\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_124_1\" name=\"wpforms[fields][124]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_124_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_124_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_124_2\" name=\"wpforms[fields][124]\" value=\"No\" aria-errormessage=\"wpforms-241-field_124_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_124_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_28-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">10. Do you have any other medical condition not listed above or do you have two or more medical conditions?<\/legend><ul id=\"wpforms-241-field_28\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_28_1\" name=\"wpforms[fields][28]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_28_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_28_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_28_2\" name=\"wpforms[fields][28]\" value=\"No\" aria-errormessage=\"wpforms-241-field_28_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_28_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_29-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"29\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">10a. Have you experienced a blackout, fainted, or lost consciousness as a result of a head injury within the last 12 months OR have you had a diagnosed concussion within the last 12 months? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_29\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_29_1\" name=\"wpforms[fields][29]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_29_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_29_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_29_2\" name=\"wpforms[fields][29]\" value=\"No\" aria-errormessage=\"wpforms-241-field_29_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_29_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_125-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"125\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">10b. Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_125\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_125_1\" name=\"wpforms[fields][125]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_125_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_125_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_125_2\" name=\"wpforms[fields][125]\" value=\"No\" aria-errormessage=\"wpforms-241-field_125_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_125_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_126-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"126\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">10c. Do you currently live with two or more medical conditions? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-241-field_126\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_126_1\" name=\"wpforms[fields][126]\" value=\"Yes\" aria-errormessage=\"wpforms-241-field_126_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_126_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-241-field_126_2\" name=\"wpforms[fields][126]\" value=\"No\" aria-errormessage=\"wpforms-241-field_126_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-241-field_126_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-241-field_127-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"127\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_127\">PLEASE LIST YOUR MEDICAL CONDITION(S) AND ANY RELATED MEDICATIONS HERE: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-241-field_127\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][127]\" aria-errormessage=\"wpforms-241-field_127-error\" required><\/textarea><\/div><div id=\"wpforms-241-field_41-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"41\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"241\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5 last \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-241-field_64-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"64\"><div id=\"wpforms-241-field_64\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-241-field_64-error\"><p>If you answered NO to all of the FOLLOW-UP questions (pgs. 2-3) about your medical condition, you are<br \/>\nready to become more physically active &#8211; sign the PARTICIPANT DECLARATION below:<br \/>\nIt is advised that you consult a qualified exercise professional to help you develop a safe and effective<br \/>\nphysical activity plan to meet your health needs.<br \/>\nYou are encouraged to start slowly and build up gradually &#8211; 20 to 60 minutes of low to moderate<br \/>\nintensity exercise, 3-5 days per week including aerobic and muscle strengthening exercises.<br \/>\nAs you progress, you should aim to accumulate 150 minutes or more of moderate intensity physical<br \/>\nactivity per week.<br \/>\nIf you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal effort exercise,<br \/>\nconsult a qualified exercise professional before engaging in this intensity of exercise.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-241-field_65-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"65\"><div id=\"wpforms-241-field_65\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-241-field_65-error\"><p>If you answered YES to one or more of the follow-up questions about your medical condition:<br \/>\nYou should seek further information before becoming more physically active or engaging in a fitness appraisal. You<br \/>\nshould complete the specially designed online screening and exercise recommendations program &#8211; the ePARmed-X+<br \/>\nat www.eparmedx.com and\/or visit a qualified exercise professional to work through the ePARmed-X+ and for further<br \/>\ninformation.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-241-field_66-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"66\"><div id=\"wpforms-241-field_66\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-241-field_66-error\"><p>Delay becoming more active if:<br \/>\nYou have a temporary illness such as a cold or fever; it is best to wait until you feel better.<br \/>\nYou are pregnant &#8211; talk to your health care practitioner, your physician, a qualifed exercise professional,<br \/>\nand\/or complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active.<br \/>\nYour health changes &#8211; answer the questions on Pages 3 and 4 of this document<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-241-field_67-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"67\"><div id=\"wpforms-241-field_67\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-241-field_67-error\"><p>You are encouraged to photocopy the PAR-Q+. You must use the entire questionnaire and NO changes are<br \/>\npermitted.<br \/>\nThe authors, the PAR-Q+ Collaboration, partner organizations, and their agents assume no liability for<br \/>\npersons who undertake physical activity and\/or make use of the PAR-Q+ or ePARmed-X+. If in doubt after<br \/>\ncompleting the questionnaire, consult your doctor prior to physical activity.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-241-field_68-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"68\"><h3 id=\"wpforms-241-field_68\" aria-errormessage=\"wpforms-241-field_68-error\">PARTICIPANT DECLARATION<\/h3><\/div><div id=\"wpforms-241-field_69-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"69\"><div id=\"wpforms-241-field_69\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-241-field_69-error\"><p>All persons who have completed the PAR-Q+ please read and sign the declaration below.<br \/>\nIf you are less than the legal age required for consent or require the assent of a care provider, your<br \/>\nparent, guardian or care provider must also sign this form.<br \/>\nI, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I<br \/>\nacknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is<br \/>\ncompleted and becomes invalid if my condition changes. I also acknowledge that the community\/fitness<br \/>\ncenter may retain a copy of this form for records. In these instances, it will maintain the confidentiality of<br \/>\nthe same, complying with applicable law.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-241-field_71-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_71\">Date <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-241-field_71\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][71][date]\" aria-errormessage=\"wpforms-241-field_71-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-241-field_72-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"72\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_72\">Signature <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-241-field_72\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][72]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-241-field_72-error\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-241-field_72-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-241-field_76-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-241-field_76\">Guardian\/Care Provider Signature<\/label><input type=\"text\" id=\"wpforms-241-field_76\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][76]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-241-field_76-error\" ><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-241-field_76-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-241-field_17-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"17\"><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-241-field_5-container { position: absolute !important; 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