Trained By Gee PAR-Q (Health Questionnaire)

Pre-Activity Readiness Questionnaire

(PAR-Q)

The information contained within this form will help your trainer decide whether you are safe to exercise or not. If there is any doubt regarding your fitness to train you should consult your GP.

Note: this information will be kept confidentially and only accessed by Trained By Gee Trainers Only.

Your Details

Full Name*

First NameLast Name

E-mail*

Date of Birth*

DayMonthYear

Phone Number*

Format: 00000000000.

Please state in which context you are filling this form out (ie for 1:1 PT, BODY BURN, FITCAMP, YOGALATES or Mum & Bub Fit)*

Health Questions

YESNO

If YES to any of the above please specify and also explain how this affects your ability to exercise or achieve your fitness goals?:

Talk to your Doctor either in person or by phone before you start becoming more physically active and/or taking a fitness appraisal. Tell your Doctor what questions you answered yes to on this form.

You may still be able to do any activity you want as long as you start slowly and build up gradually or it may be that you need to restrict your activities to those which are safe for you.

If you have answered YES to any of the questions above, a reasoned judgement will need to be made as to whether consent is required from your Doctor prior to commencing any physical activity with Georgia or Trainers.

If Trained By Gee decides that you need consent from your Doctor to commence any program of activity with us, you may wish to continue training, however we will require written consent from yourself to do this and a signed waiver form.

Lifestyle Questions

SedentaryActivePhysically demanding

YESNOVape

YESNO

How many units per week?

How many hours do you regularly sleep at night?*

YESNO

Please describe your current activity levels (ie spin class x 2pw, gym x 3pw, Pilates, 10,000 steps per day or N/A)

If there is any other information you would like me to know please add it below (ie perimenopausal, prenatal, postpartum etc)

Are you currently using any GLP-1 medications for weight loss? (If yes, please state which type and dosage):

How did you hear about me? (ie Facebook, Instagram, Friend Recommendation)

Please confirm the area that you live in (ie Tonbridge or TN11)

Emergency Contact

Full Name*

First NameLast Name

Phone Number*

Format: 00000000000.

Relationship*

By submitting this form, you agree to Trained By Gee capturing photos and/or video during sessions, classes, or events. This content may be used for marketing, promotional materials, and social media.