Pre-Exercise Health & Fitness Questionnaire/FinFit Studio

Physical Activity Readiness Health Questionnaire

PARQ
What class you attending with Jana Finson?

9.15 Alcester Beginner Pilates Tuesday Scout centre9.00 Alcester Beginner Pilates Thursday Scout Centre6.30pm Alcester Pilates Tuesday AGS10.15am Rowington Keep Fit Gent’s Monday10.30am Alcester Keep Fit 60+ Tuesday Scout Centre10.15 Alcester Keep Fit 60+ Thursday Scout Centre10.15 Alcester Keep Fit 60+ Friday Scout Centre1:1 Private Pilates Session1:1 Personal Training Session
Name*

First NameLast Name
Gender

FemaleMaleOther
Date of Birth*

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityState

Postcode
Occupation
Phone Number*
Email*
example@example.com
Emergency Contact Person*

NameRelation to you
Emergency Contact Phone Number*

Please specify if you have one of the following pre-existing condition*

	Yes	No
Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke?
Do you ever feel faint , dizzy or lose balance during physical activity/exercise?
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
If you have diabetes (type I or II) have you had trouble controlling your blood glucose in the last 3 months?
Is your doctor currently prescribing medication for blood pressure or a heart condition?
Do you have a joint or bone problem that could be made worse by a change in your physical activity?
Do you ever experience unexplained pains or discomforts in your chest at rest or during physical activity/exercise?
Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?

If you answered yes to any of these questions please give details
If you answered 'Yes' to any of these questions, you should obtain written medical clearance from an appropriate health professional prior to training commencing.

(If you can’t provide a medical clearance form, you are confirming that you are attending class/session at your own risk).
Are you currently taking any medications? If so please also specify what they are prescribed for.*
Are you pregnant or have you had a baby in the last six months?*

Please tick if you have ever experienced any of the following conditions:*

	Yes	No
Carpal Tunnel Syndrome (Wrist/finger/hand forearm - pain/numbness or tingling)
Knee Pain (Side, front or back)
Upper Back/Neck/Shoulder Pain
Separation of your abdominal muscles
Joint/Muscle Pain
Buttock/Piriformis Pain/Sciatica
High blood pressure
High cholestrol
High blood sugar levels
Any injuries in last 12 months
Long Covid symptoms/chronic fatigue
Shortness of Breath

If yes to any of above please give details
Do you smoke?
Any barriers to exercise?

TimeFamilyWorkunfitlack of motivationinjurylack of knowledgeOther
Can you briefly detail your past and current exercise levels*
What type of exercise do you enjoy the most?
What type of exercise do you dislike the most?
What health and fitness goals would you like to achieve in the next 3 months?
What are your main reasons for starting my class/PT/Pilates session?

General fitnessWeight lossStress ManagementMuscular strengthMobility & FlexibilityImprove self esteemTo improve mental well beingMotivation
Is there any other information you would like me to be be aware of?
Client information - Liability waiver -

DISCLAIMER - All FinFit Studio exercise is conducted at your own risk!

Please seek advice from a doctor if you are unsure of suitability for exercise. These exercises are not suitable for pregnant women. You are participating voluntarily, and you are entirely responsible for your own safety.

I agree that it is my responsibility to determine whether I am fit enough to exercise. If I feel unwell, or have any unusual pain or discomfort I will not participate in the exercise class/session. If I feel unwell during the session/class, I will stop and seek medical attention. It is the intention of the participate by signing below that I take full responsibility for any injuries that occur during or after the exercise session/class.
Date

MonthDayYear
Date
Name

First NameLast Name
Signature

Clear
Should be Empty:

Physical Activity Readiness Health Questionnaire

If you answered 'Yes' to any of these questions, you should obtain written medical clearance from an appropriate health professional prior to training commencing.