8 Week Transformation Program Consultation Form
Please complete this form to help us tailor your personal training experience and ensure your safety.
Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
-
Month
-
Day
Year
Date
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Physical Activity Readiness Questionnaire (PAR-Q)
Please answer the following health questions.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Yes
No
Do you feel pain in your chest when you do physical activity?
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Yes
No
Is your doctor currently prescribing any medication for your blood pressure or heart condition?
Yes
No
Do you know of any other reason why you should not do physical activity?
Yes
No
If you answered YES to any of the above, please provide details:
Current Activity Level
Sedentary (little or no exercise)
Lightly active (light exercise/sports 1-3 days/week)
Moderately active (moderate exercise/sports 3-5 days/week)
Very active (hard exercise/sports 6-7 days/week)
Other
What are your main fitness goals for this 8 week program?
Do you have any injuries, medical conditions, or limitations we should be aware of?
Are you currently taking any medications? If yes, please specify.
Additional Comments or Information
Consent & Agreement
Please read and agree to the following terms before submitting.
Signature
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