Consultation Form & PAR-Q
info@trainwithtati.com / 07300298393
Client Name:
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Phone Number
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Country code (+44)
Phone Number
Email
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Date of Birth
Occupation:
Activity Level: SEDENTARY- LIGHTLY ACTIVE(5k-6k steps daily)- ACTIVE- VERY ACTIVE
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Goal Notes: (Timeframe? What worked well previously? Main body areas of concern? How do you feel now? Why do you want to achieve your goal? How will this make you feel?
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Review of Health Check/Body Stats:
Height:
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Weight:
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I know what I expect from a personal trainer. What is it you expect?
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What is your main goal?
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Mobility
Strength
Fat Loss
Endurance
Build Muscle
Other
What are your goals? If a show, shoot, holiday etc. please provide time frames. Why are these goals important to you? Please provide as much information as necessary.
Please highlight any previous and current injuries that may affect training. Please explain when it happened, treatments and how it affects/affected you. Please highlight any current prescribed/non prescribed medication you are currently taking and the reason
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What do you do for a job? Please include working hours (both in and out of work)
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What is your current weekly training routine, what sports, gym and how many times per week, including cardio? Please attach any programmes you currently follow.
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Which exercises do you like/ dislike? What training do you enjoy, please include cardio types you prefer etc.?
How would you rate your training experience out of 1-10 (10 being well experienced, train hard, understand majority of exercises, 5 or below being would need help, guidance with form, technique, exercises etc.)?
How many days per week are you prepared to exercise?
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Please what time of day do you train at? How many times can you train per week?
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How many meals a day do you consume?
Review of Food Diary/MFP information from previous interactions/pre
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consult email:
Avg. Calorie Intake:
Avg. Water Intake:
Is your menstrual cycle regular? Please give details e.g. 28 days, 5 days duration, regular each month
Have you or do you currently take the contraceptive pill or any form of contraception. Please provide which type, how long it was or has been.
Have you ever completely lost your cycle? Please provide detail is possible.
PAR-Q, Medical History Form
I certify that my answers to the questions below are true and complete to the best of my knowledge. I understand and agree that it is my responsibility to inform my Trainer of the conditions or changes in my health, now and on-going, which might affect my ability to exercise safely and with minimal risk of injury. I also sign to say that I have sought medical advice on any/all questions within this PAR-Q form that I have answered ‘YES’ to and have been cleared to partake in the upcoming advised exercise programme.
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Rows
YES
NO
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
Do you feel pain in your chest when you perform physical activity?
In the past month, have you had chest pain when you were not performing any physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
Do you know of any other reason why you should not engage in physical activity?
If you have answered YES to one or more of the above questions, consult your GP before engaging in physical activity. Tell your physician which questions you answered YES to. After medical evaluation, seek advice from your GP on what type of activity is suitable for your current condition.
Client Signature:
Trainer Signature
Date:
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Month
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Day
Year
Date
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