Instructions: Step 1. Read the question displayed below. Step 2.  Answer it honestly by selecting Yes or No. Step 3. Then click the forward arrow [=>] to advance to the next question. Answer all 7 questions.

Your Score will appear in this box after you finish the last question.

[Note: If you make an error, click the "Back" button of your browser to reset the quiz and begin again from the start.] 

1. 1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

   1.   Yes    Yes
   2.   No    No

2. 2. Do you feel pain in your chest when you do physical activity?

   1.   Yes    Yes
   2.   No    No

3. 3. In the past month, have you had chest pain when you were not doing any physical activity?

   1.   Yes    Yes
   2.   No    No

4. 4. Do you lose your balance because of dizziness or do you ever lose consciousness?

   1.   Yes    Yes
   2.   No    No

5. 5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?

   1.   Yes    Yes
   2.   No    No

6. 6. Is your doctor currently prescribing drugs (for example, water pills) for a blood pressure or heart condition?

   1.   Yes    Yes
   2.   No    No

7. 7. Do you know of any other reason why you should not do physical activity?

   1.   Yes    Yes
   2.   No    No