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Moto Gymkhana Stage 3

2025 / Georgian Championship / Moto Gymkhana / Standings / Scooters
Pos.		Rider		Motorcycle	Best Lap	Add. Pts	Pts.	Points

Please fill in the medical questionnaire, which is drawn up according to the FIM medical code. Please mark the answer: Yes or No It is not allowed to provide false information or intentionally conceal information.

Loss of consciousness for any reason dizziness or headache

Yes

Eye problems (except glasses)

Yes

Asthma

Yes

Allergy

Yes

Diabetes

Yes

Heart problems

Yes

Blood pressure disorder

Yes

Stomach problems (ulcer, etc)

Yes

Uro-genital problems

Yes

Epilepsy or convulsions

Yes

Mental or nervous disorder

Yes

Problems with arms or legs incl.muscle cramp or joint stiffness

Yes

Blood disorder with tendency to bleeding

Yes

Blood group

Surgeries

Yes

Do you take any medicine or drugs regularly?

Yes

Have you had a tetanus shot? (Required) within the last 10 years

Yes

Have you had general anesthesia?

Yes

Have you had any complications during anesthesia?

Yes

Are you under a doctor's care?

Yes

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