Muskathlon medical survey

Thank you for taking the time to complete this survey. All questions are mandatory, but you can skip those that do not apply to you by filling "-" in the field provided.
If you wish to correct other information, please go to your home page.

What is your main sport activity ? *

Do you sport ? *

How many hours per week ? *

Number of years engaged in the sporting activity *

Sport experience (in years) *

Average km per year *

At what level (beginner, advanced etc) *

Climbing experience *

Health Insurance *

Policy number *

Height (in cm) *

Weight (in kg) *

Blood type and Rhesus factor *

Do you suffer from an injury ? If yes, which ? *

When did your injury start ? *

How did you deal with it ? *

What is the result ? *

Do you use drugs or medication ? If yes, what type ? *

What is the dose of your medication ? *

Are you treated/have you been treated by a medical specialist, and if so, for what reason ? *

Do you smoke ? *

What do you smoke ? *

How many a day ? *

Since what age have you been smoking ? *

How many alcoholic drinks per week do you consume ? *

Do you consume other stimulants/drugs ? *

What kind ? *

How often ? *

Do you ever have pressure or pain in your chest during or after exercise ? *

Did you ever notice that your heart jumps or skips a beat ? *

Have you ever fainted or been dizzy during exercise ? *

Has someone (in the past) told you to stop exercising because of a heart disease or another illness ? *

Are you or have you ever been treated for heart problems ? *

Are you or have you ever been treated for heart problems ? *

Are you or have you ever been treated for increased/decreased blood pressure ? *

Have you ever been or are you being treated for high cholesterol ? *

Do/did you have rheumatic fever ? *

Have you ever been or are you being treated for diabetes ? *

Have you ever been or are you being treated for asthma ? *

Did you ever have problems with breathing or coughing during or after exercise ? *

Do you use or have used in the past inhalers ? *

Do you have an allergy that limits you in your daily life ? *

Do you frequently suffer from sinusitus ? *

Do you suffer from headaches that limit you in your everyday life ? *

Do you suffer from vertigo ? *

Do you have vision problems ? *

Do you have trouble hearing ? *

Do you have tingling and/or weakness in the arms and/or legs ? *

Do you have epilepsy ? *

Do you have a disturbed appetite ? *

Do you suffer from stomach pain, heartburn or belching ? *

Do you suffer from intestinal problems ? *

Has your weight changed by more than 5% in the last two years ? *

Do you have problems with your neck/shoulders ? *

Do you have problems with your back ? *

Do you have problems with your elbows/arms ? *

Do you have problems with your hips/knees ? *

Do you have problems with your ankles/feet ? *

Do you have other symptoms to your muscles, tendons or joints ? *

Do you suffer from skin conditions that hinder you in your daily work ? *

Did you have a longer period in which you had a fever, flu or a severe viral infection (myocarditis, Pfeiffer/Mono) ? *

Do you sometimes notice extreme fatigue that is not in line with your normal workload ? *

Have you in the past two months suffered from fatigue or deterioration of your physical condition ? *

Have you ever had Lyme disease ? *

Are there other particular details regarding your health ? *

Has someone in your family suddenly and unexpectedly deceased from a disease/ailment ? *

Does anyone in your family have high blood pressure ? *

Is anyone in your family being treated for a heart disease ? *

Are there people in your family with cancer ? *

Are there other serious diseases in your family? : *

Are there other particular details in your family regarding your health ? *

Do you have experience with or are you trained in CPR/AED ? *