RevUp/Reload Paperwork

  • RevUp Reload Paperwork

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  • What type of membership do you have with LSPR?*
  • How would you rank your overall physical fitness level?*
  • How many days per week do you engage in aerobic exercise for at least 30-60 minutes in duration? (Examples: fitness walking, cycling, active sports, etc.)*
  • How many times per week do you engage in strength training sessions? (Examples: back squats, deadlifts, or bench press)*
  • How often do you exercise at a fitness center or gym?*
  • How would you rate your overall health?*
  • How would you rank your overall nutrition or diet?*

  • Health Status Questionnaire

  • Have you had a heart attack, stroke, or heart surgery?*
  • Has your doctor said you have cardiovascular, pulmonary, metabolic or other significant disease?*
  • Has your doctor said that you have a heart murmur or irregular heart beat?*
  • During or right after exercise, do you have pains or pressure in the left or mid-chest area, left neck, shoulder or arms?*
  • Do you experience shortness of breath at rest or with mild exertion?*
  • Do you experience dizziness/fainting spells at rest or with exertion?*
  • Do you have insulin-dependent diabetes or take medication to control your blood sugar?*
  • Have you experienced leg pain upon exertion?*
  • Has your doctor said that you have a musculoskeletal disorder that could be made worse by physical activity (i.e., bursitis, arthritis, joint or muscle disorder, etc.)?*
  • Are you currently taking prescription medication for an underlying disorder (i.e., heart, lung, GI, blood) that may impact your ability to exercise? If yes, please let the staff know.*
  • Are you currently pregnant or within six weeks postpartum?*
  • Do you have a medical condition not mentioned here which might affect your ability to participate in an exercise program (i.e., seizures, emphysema, asthma, etc.)?*

  • Par-Q & You

    A Questionnaire for people aged 15-69.
  • Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
  • Do you feel pain in your chest when you do physical activity?*
  • In the past month, have you had chest pain when you were not doing 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?*
  • Do you know of any other reason why you should not do physical activity?*
  • Is your doctor currently prescribing drugs for your blood pressure or heart condition?*

  • If you answered: YES to one or more questions

    • Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.
    • You may be able to do any activity you want - as long as you start slowly and build up gradually. Or, you may need to restrict your actvities to those which are safe for you. 
    • Talk with you doctor about the kind of activites you wish to participate in and follow his/her advice. 
    • Find out which community programs are safe and helpful for you. 

  • If you answered: NO to all questions

    • If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can: 
      • Start becoming much more physcially active - begin slowly and build up gradually. This is the safest and easiest way to go. 
      • Take part in a fitness appraisal - this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. 
      • It is also highly recommended that you have your blood pressure evaluated. 
      • If your reading is over 144/94, talk with your doctor before you start becoming much more physically active. 

  • DELAY BECOMING MUCH MORE ACTIVE:

    • If you are not feeling well because of a temporary illness such as a cold or fever - wait until you feel better.
    • If you are or may be pregnant - talk to your doctor before you start becoming more active. 
    • No changes permitted. You are encouraged to photocopy the PAR-Q but only if you use the entire form. 
    • NOTE: If the PAR-Q is being given to a person before he or she particpates in a physical activity program or fitness appraisal, this section may be used for legal or administrative purposes. 

  • RevUp 6 Week Service Agreement:

    • RevUp includes 6 small group sessions with a personal trainer over a 6 week period. 
    • RevUp is small group training and consists of 4 to 7 participants in each group.
    • The 6 small group sessions must be completed within the 6 week period.
    • Any sessions not completed in the 6 week period will not be made up after the 6 week time period unless paid and enrolled in the next RevUp Reload.
    • All payments must be made in full upon enrollment.
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