PAR-Q
physical activity readiness questionnaire
Name
First Name
Last Name
Please put email or phone number for your preferred method of contact
example@example.com
How would you describe your current fitness level?
Beginner / returning after time off
Somewhat active
Consistently active
Advanced
Are you currently exercising? If so, how often and what do you usually do and what are you currently doing? If not, what have you done in the past that you enjoyed, why did you stop, and what feels realistic for you to start again now?
Please provide a brief history of your exercise history. Have you ever engaged in a resistance training program?
Do you have any current injuries or previous injuries that I should be aware of?
Do you currently experience pain during daily activities or exercise? If so, where and during what movements?
Are there any movements you feel uncomfortable, nervous, or unsure performing? (e.g., squats, deadlifts, overhead movements) Are there any forms of exercise you enjoy?
Are there any forms of exercise/physical activity that you dislike?
Are you currently under the care of a physician? Has a doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
In the past 3 months have you:
experienced chest pain
lose balance because of dizziness or lose consciousness?
have a bone or joint problem (back, knee, hip, shoulder, etc.) that could be made worse with exercise
Do you have high blood pressure or have you ever been told you do? Has a doctor ever prescribed blood pressure or heart medication?
Do you experience shortness of breath at rest or with mild exertion?
Have you had surgery in the past 12 months? or any chronic pain?
If you have answered yes to any of the about questions please elaborate your answers here.
Is there anything else about your body, health, or movement history that would help me coach you more effectively?
How would you rate your sleep most nights? How would you describe your current stress level?
What is it that appeals to you about online(virtual) coaching?
Convenience and flexibility of of schedule
Regular accountability
Reoccurring feedback on form and progress from a certified coach
Personalized programming
Technology Integration and progress tracking via the app
Other
What does progress look like to you in the first 4–8 weeks?
If you imagine yourself at age 70, 80, or even 100, what physical activities would you like to still be capable of doing? These could range from everyday tasks to hobbies or athletic pursuits. What specific abilities are important enough to you that you would begin training for them now in order to preserve your quality of life in later years?
Where do you see yourself exercising? What access to equipment do you have? Are you open to joining a gym or purchasing equipment? How many days a week? Any preferred days to train or not train?
What made you decide to start personal training now? If this was a huge success, what would your life look like in 6–12 months, and why does that matter to you?
As you pursue your goals, what kind of person do you want to become? What qualities matter most to you?
I acknowledge that participation in personal training and fitness activities involves inherent risks, including injury, and I voluntarily assume full responsibility for my participation. I hereby release and hold harmless the trainer and facility from any and all claims, liabilities, or damages arising from my participation, except in cases of gross negligence. Please type your name for consent.
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