PARQ -Terms & Conditions
Hey- If you're between 15 and 69 years old, the PAR-Q will help you figure out if you should check in with your doctor before making big changes to your physical activity. If you're over 69 and not used to being active, it's a good idea to talk to your doctor first.Please take a moment to read each question carefully and answer honestly. Everyone who signs up for our services—whether it's in person or online—needs to fill out this form before getting started.
Full Name
First Name
Last Name
Phone Number
-
Phone Number
Date of Birth
DD/MM/YYYY
Email
example@example.com
Next of kin:
Name & who:
Contact details:
Do you suffer with any of the following?
Asthma
Cancer
Cardiac disease
Diabetes
Hypertension (high blood pressure)
Psychiatric disorder
Epilepsy
Please tick the following if the answers apply to you: Please note if you tick any of the questions (apart from 'none of the above') you will need to be asked to confirm with your GP that you are safe to exercise.
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you feel pain in your chest when you do physical activity?
Do you have a bone or joint problem ( for example back, knee or hip) that could be made worse by a change in your physical activity?
In the past month, have you had a chest pain when you were not doing physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Do you know of any other reason why you should not take part in physical activity?
None of the above.
Are you currently taking any medication?
Yes
No
if yes, note what medication:
What is your Gender?
Male
Female
Other
Do you have any medication allergies?
Yes
No
Not Sure
If yes, please note below:
Do you currently smoke?
Please Select
Yes
No
How often do you consume alcohol?
Daily
Weekly
Monthly
Occasionally
Never
Are you currently using any weight loss drugs?
No
I have tried them in the past.
Currently on them.
What excess do you have to gym equipment outside of our in person sessions?
No equipment
Mat, resistance bands, and small dumbbells/barbell/kettlebell.
Full Gym access.
Submit
Should be Empty: