PAR-Q Questionnaire

PAR-Q AND YOU PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

Many health benefits are associated with regular exercise, and the completion of PAR-Q is a sensible first step to take if you are planning to increase the amount of physical activity in your life. For most people physical activity should not pose any problem or hazard.

PAR-Q is designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Common sense is the best guide in answering these few questions.

1. Has your doctor ever said that you have a bone or joint problems, such as arthritis that has been aggravated by exercise or might be made worse with exercise? *

Yes

2. Do you have high blood pressure? *

Yes

3. Do you have low high blood pressure? *

Yes

4. Do you have Diabetes Mellitus or any other metabolic disease? *

Yes

5. Has your doctor ever said you have raised cholesterol (serum level above 6.2mmol/L)? *

Yes

6. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

Yes

7. Have you ever felt pain in your chest when you do physical exercise? *

Yes

8. Is your doctor currently prescribing you drugs or medication? *

Yes

9. Have you ever suffered from unusual shortness of breath at rest or with mild exertion? *

Yes

10. Is there any history of Coronary Heart Disease in your family? *

Yes

11. Do you often feel faint, have spells of severe dizziness or have lost consciousness? *

Yes

12. Do you currently drink more than the average amount of alcohol per week (21 units for men and 14 units for women)? *

Yes

13. Do you currently smoke? *

Yes

14. Do you NOT currently exercise on a regular basis (at least 3 times a week) and/or work in a job that is physically demanding? *

Yes

15. Are you, or is there any possibility that you might be pregnant? *

Yes

16. Do you know of any other reason why you should not participate in a physical activity programme? *

Yes

If you answered YES to any of the questions above please give details:

If you answered YES to one or more questions:

If you answered NO to all questions:

If you answered PAR-Q accurately, you have reasonable assurance of your present suitability for a graduated exercise program and a fitness appraisal

I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities, which may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me.

Gender *

Male

Female

Non-Binary

I prefer not to say

Additional Note: I have taken medical advice and my doctor has agreed that I should exercise.

ONLINE COACHING - Terms and Conditions

I agree to these terms and understand the following: *

This agreement is for a minimum of 6 months from the date of: *

Please note all payments are final - there are NO refunds unless stated by your coach or outlined in the Terms and Conditions which is linked below.

Time to Fast Track your results!

Client Signature *

Clear

What is your NUMBER 1 Goal & Why? *

Why is this goal important to you? *

Have you ever had any bad experiences or negative feelings with exercise programs? If so, please describe. *

What do you hope to achieve from your exercise program? Please answer below so we can craft the right program for you

What best describes your goal? *

Drop body fat, increase strength and muscle definition

Gain weight, increase muscle mass and strength

Improve athletic performance - strength and power

Improve cardiovascular endurance

Improve overall health

Do you have ANY type of injury that could hold us back? *

Is your job physical or sedentary? *

How many times a week can you go to the gym - Please be SURE; this determines how your program is made *

3 days a week

4 days a week

5 days a week

How would you rate your training experience in the gym? (Please be as accurate as you can - and pick the option that BEST describes where you are at currently) *

Beginner - "I am not comfortable doing heavy barbell squatting, deadlifting, & bench pressing. I am not able to set up a squat rack...& I cannot do push-ups or pull ups yet. I am yet to run at least 5k (3 miles)"

Advanced - "I have done heavy barbell squats, deadlifts and bench pressing in the past. I am comfortable operating gym machines & I have ran a comfortable 5k (3miles) in the past. I am able to do push ups and pull ups once I get back in to training."

NUTRITIONAL ASSESSMENT

This form has been designed to assess your current nutrition and previous nutritional habits. Please answer as accurately and honestly as possible. We cannot formulate your meal guide without this - so please fill it out accurately and honestly.

Are you allergic to any foods? (please name each food) *

Are there any foods that you refuse to eat? *

Name 3 Breakfast Options That you are willing to prepare in the mornings... *

Name 3 Lunch Options That you are willing to prepare in the afternoon... *

Name 3 Dinner Options That you are willing to prepare in the evening... *

Please write out your favourite snack options: *

Please write out your favourite alcohol options: *

Please write your 3 favourite fast food options *

By signing below you are agreeing that this information is accurate to the best of your knowledge.

LET’S BUILD AN AMAZING FITNESS COMMUNITY: PLUS-TWO

We want to build an awesome fitness community here, so we’re asking for your input. Who are your “Plus-Two” friends, family, co-workers, or neighbours who could benefit from Online Coaching?

Your two referrals (a.k.a. your “Plus-Two”) will each receive a FREE transformation coaching consultation where I will help them outline their goals and a path to get there. So, who comes to mind when you think of your Plus-Two?

Phone Number (optional):

Relationship (optional): *

Phone Number(optional) *

Their Email Address *

THANKS FOR HELPING SPREAD THE GIFT OF IMPROVED HEALTH AND FITNESS!

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