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Golf Fit Academy PAR-Q and DISCLAIMER

Golf Fit Academy PAR-Q and DISCLAIMER

Hi there, please fill out and submit this form.
40Questions
  • 1
    Enter full name
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    Add date
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    Pick a Date
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    Add area or country code
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  • 7

    "How's your day?"

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  • 8
    Country / Town / City Address
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  • 9

    "Perfect - So I'm just going to ask a handful of questions to find out a little more about where you are today, and where you are looking to get to.

    And if it sounds like I can help, we can go through how best to get you to your goals!

    Also we can make a decision on whether you are ready to be apart of this program and if I am a fit to get you there.

    Is that ok with you?"

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  • 10

    So tell me a bit about yourself.

     

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  • 11
    Please indicate whether you or a member of your immediate family has suffered from;
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  • 12
    if you are an ex-smoker tick yes
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    eg: Pain, Goals or weaknesses
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  • 22
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  • 23
    @gmail
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  • 24
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  • 25
    Please complete this energy diary for one day; typically this would be a day during the week.  Fill out the table hour by hour, by noting minutes spent on each activity zone Example: if you wake up at 7.30 AM and starts walking around in your home until 8.00 AM you would enter “30 min” under “Sleeping” and “30 min” under “Standing / walking” in the line starting with “7:00”
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  • 26
    I can do?
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  • 27
    What is your main reason for wanting to get an online coach for you golfing needs and not just continue doing what you're doing?  
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  • 28
    Please indicate the frequency of your nutritional intake, using the following key: Habitually- On a daily basis Often- Roughly 3 times per week Occasionally- Roughly once per week Rarely- Roughly 2 times per month Never- Complete avoidance 
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  • 29
    Please use the following section to describe your personal nutritional goals:
    • To gain lean mass
    • To lose weight
    • To improve sporting performance
    • To achieve a healthy diet
    • Others
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  • 30
    Please indicate which level best describes you, by ticking the relevant box:
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  • 31
    On your new plan, would you prefer smaller more frequent meals? Or larger, less frequent meals? Please explain your preference.
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  • 32
    When would you like to achieve your personal weight goals?
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  • 33
    Have you previously tried to achieve these goals in the past?
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  • 34
    And what challenges did you encounter when attempting to achieve your personal nutritional goals?
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  • 35
    Please indicate any instances or situations which may prevent you from achieving your goals?
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  • 36

    Disclaimer 


    Please read this document carefully. If you agree to these terms, when you have entered your name in block capitals, or sign and date at the bottom of the page.


    Nutritional Questionnaire 


    I certify that all the information I have provided in the nutrition questionnaire is accurate and complete to the best of my knowledge as of the date of my signature below. I agree to accept responsibility for omissions regarding my failure to disclose any past or currently existing health/medical conditions. 


    Medical Advice


    Chris Birch only provides general nutritional health information, and should be used for informational purposes only. Chris Birch does not provide any medical diagnoses, symptom assessments, health counselling or medical opinions for individual clients. 


    Copyright


    I acknowledge that the information provided to me is for my information only and is copyright of Chris Birch. I agree that I shall not share, post, copy or distribute the information on any form of media or share with any individuals. I accept that there are no refunds for any reason. 


    Liability 


    I  acknowledge that Chris Birch is not responsible for any liability, claims, demands, losses, costs, damages, expenses, actions, causes of action, suits, or other proceedings by whomever made, sustained, brought or prosecuted in any manner based upon, occasioned by or attributable to my use of the information provided by Chris Birch. 

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    Thank you for taking the time to give me as much information to be able to help you!

    I will contact you with a follow up call at a convenient time for you.

    Chris 

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  • 38
    either type your name or sign
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  • 39
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  • 40
    Have you received the COVID-19 (Yaba) vaccination?
    Please Select
    • Please Select
    • No
    • Yes 1 does
    • Yes 2 does
    • Yes 3 does or more
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