Muskathlon medical survey

The medical form has several reasons to be. First, it allows the Muskathlon doctor to assess and apprehend the risks in the context of the sport challenge undertaken. Then, it can be useful in the case of a medical incident, in order to react in the best and most effective way possible on the spot. We therefore ask you to fill in this form carefully, to bring the required medical documents (eg: allergy certificate, implant certificate, cardiac simulator certificate), and to give them to our doctor on site. As in any medical information sharing, the 4Medic team is also subject to professional secrecy. All shared information will be deleted after the Muskathlon. Thank you so much !

Age (years) *

Height (m) *

Weight (kg) *


Do you have allergies? *

If yes, which:

Do you know your blood type (A, B, AB, O)? *

If yes, which is it:

Have you ever received a blood bag? *

If yes, have some complications followed?

Do you take any anticoagulent medication (for instance ASS, Marcoumar, Heparine, Clopidogrel, Ticagrelor, Eliquis, Xarelto)? *

If yes, which ones:

Do you regularly take other medications? *

If yes, which ones (including dosages):


Have you ever had surgery in the past? *

If yes, which were these surgeries?

Are you subject to narcosis problems? *

If yes, describe them:

Do you have heart disease? *

If yes, which ones:

*Give more details here:

Do you have a disease of the respiratory tract/lungs? *

If yes, which ones:

Is thyroid disease known to you? *

If yes, which ones:


Do you have diabetes? *

Do you have any diseases/symptoms of the gastric or intestinal tract? *

If yes, which ones:

Have you been diagnosed with chronic kidney disease? *

If yes, which ones:

Have you been diagnosed with chronic liver disease? *

If yes, which ones:

Have you been diagnosed with a disease of the nervous system? *

If yes, which ones:

*Give more details here:


Do you suffer from pain in the spine, joints or muscles? *

If yes, which ones:

*Give more details here:

Do you have an infectious disease? *

If yes, which ones:

Have you been diagnosed with a mental illness? *

If yes, which ones:

Do you have other diseases, not listed above? *

Do you smoke? *

If yes, how often daily:

Do you drink alcohol daily? *

If yes, which alcohol and in which quantity:

Do/did you consume drugs? *

If yes, which one(s):

For women: are you pregnant?