Sarkodie Fitness & Foods - Readiness & Consent Form (PAR-Q)
Complete this form before starting your fitness and nutrition coaching. This ensures your plan is tailored to you while keeping you safe.
Personal Information
In this section, we’ll gather some basic details about you to help tailor your fitness and nutrition plan. Your personal information will be kept confidential and used only to personalise your coaching experience.
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Date of Birth
*
Height (cm)
*
Weight (kg)
*
Neck (cm)
*
Natural Waist (cm)
*
Navel (cm)
*
Hips (cm)
*
What is your current occupation or status?
*
Student
Employed
Self-employed
Unemployed
Do you work from home or in an office?
*
Work from home
Work in an office
Hybrid (both home and office)
Not employed
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Health & Readiness (Answer honestly – this helps ensure your safety.)
Answer the following health-related questions:
Has a doctor ever told you to avoid physical activity due to a health condition?
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Yes
No
Do you experience chest pain, dizziness, or loss of consciousness during exercise?
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Yes
No
Do you have any injuries, medical conditions, or take medications that may affect exercise?
*
Yes
No
Do you have any dietary restrictions or allergies?
*
Yes
No
If answered 'Yes' to any questions above - please explain here
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Fitness & Nutrition
In this section, we'll get a better understanding of your fitness goals, current activity level, and any dietary preferences or restrictions you may have. This information will help us create a personalised fitness and nutrition plan that aligns with your objectives and lifestyle.
What is your main goal?
*
Fat loss
Muscle gain
General fitness & health
How active are you on a daily basis?
*
Very active (10,000+ steps/day)
Moderately active (7,000-10,000 steps/day)
Lightly active (3,000-7,000 steps/day)
Sedentary (Less than 3,000 steps/day)
What is your level of experience with the gym?
*
Beginner (I’ve just started or have minimal experience with the gym)
Intermediate (I’ve been going for a while and am familiar with exercises)
Advanced (I’ve been training consistently and have a strong understanding of workouts)
Have you tracked your food intake before (e.g. using MyFitnessPal?)
*
Yes, I track my food regularly.
Yes, but only for a short period.
No, I’ve never tracked my food before.
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Tracking & Progress
To ensure the best results, we’ll track your progress using key metrics like weight, steps, and progress photos. This helps us make informed adjustments to your fitness and nutrition plan. In this section, you’ll provide details on your tracking tools and give consent for progress photos.
Do you have a Bluetooth scale?
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Yes
No, but I will get one.
Do you have a smart watch/step counter watch (Fitbit)?
*
Yes
No, but I will get one.
Have you downloaded MyFitnessPal and the "Strong" app?
*
Yes
No, but I will get one.
Are you comfortable sending weekly progress pictures? (Mandatory but with privacy options.)
*
Yes, I am
No, but I will send them with my face blurred.
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Consent & Agreement
By completing this form, you acknowledge that the information provided is accurate to the best of your knowledge. You also consent to participating in fitness and nutrition coaching, understanding the potential risks associated with physical activity. Additionally, you agree to allow Sarkodie Fitness to use your progress photos for social media and marketing purposes, unless otherwise stated. Refund Policy: Please note, we do not offer refunds for past payments. However, you can cancel future payments at any time by contacting us before your next billing cycle. By continuing with the subscription, you agree to these terms.
Do you accept responsibility for any risks related to exercise and nutrition coaching?
*
Yes
Do you consent to Sarkodie Fitness collecting and storing your information?
*
Yes
Do you allow Sarkodie Fitness to use your progress pictures for social media and marketing?
*
Yes
Yes, but keep me anonymous
I agree that there are no refunds, and the most I can do is cancel my next payment.
*
Yes
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Signature
Submit
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