PAR Q Personal Training

PHYSICAL ACTIVITY READINESS

Please answer all questions accurately and honestly to allow us to fully determine your individual needs.

Date

Email*

First Name*

Last Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Gender

Age

Do you have high cholesterol?

Yes
No

Has your doctor ever said that you have heart trouble?

Yes
No

Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?

Yes
No

Has your doctor ever told you that your blood pressure was too high?

Yes
No

Are you over 65 years of age and not accustomed to vigorous exercise?

Yes
No

Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?

Yes
No

The following information will be treated as privileged

Do you ever feel weak, fatigued, or sluggish?

Yes
No

Do you need several cups of coffee to keep you going throughout the day?

Yes
No

Do you often experience digestive difficulties?

Yes
No

Check This Box to Agree The Below Disclaimer*

I Agree

Any questions you have answered yes to you must consult your doctor before undertaking any physical activity to get approval for exercise. I have read, understood and completed questionnaire. I can confirm I am voluntary engaging in an acceptable level of exercise and i understand the risk of injury involved in exercise.

Personal Training Terms & Conditions