• Physical Activity Readiness Questionnaire for New Clients

    Please fill out this form to help us understand your health status and exercise readiness.

  • Client Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.

  • PAR-Q+ Health Screening

  • Has your doctor ever said you have a heart condition or 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 ever lose consciousness?*
  • Do you have any bone or joint problem that could be made worse by a change in your physical activity?*
  • Are you currently prescribed medication for blood pressure or a heart condition?*
  • Do you have any other medical condition(s) not listed above that could affect your ability to exercise safely?*
  • Do you have any previous injuries or surgeries?*

  • Lifestyle & Goals

  • How would you describe your current physical activity level?*

  • Informed Consent & Liability Waiver

  • Informed Consent & Liability Waiver

    I acknowledge that I have voluntarily chosen to participate in a program of progressive physical exercise. I understand that there are inherent risks in physical activity and I agree to assume full responsibility for any risks, injuries, or damages, known or unknown, which I might incur as a result of participating. I have answered all questions truthfully and to the best of my knowledge.

    By signing below, I agree to participate and accept these terms.
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