PARQ

Date of Birth (DD/MM/YY) *

Emergency Contact Name *

Emergency Contact Number *

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

Yes No

Do you feel pain in your chest when you perform physical activity? *

Yes No

In the past month, have you had chest pain when you were not performing any 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 for a heart condition? *

Yes No

Do you know of any other reason why you should not engage in physical activity? *

Yes No

If you have answered yes to one or more of the above questions, consult your doctor before engaging in physical activity. Tell your doctor which questions you answered yes to. After medical evaluation, seek advice from your doctor on what type of activity is suitable for your current condition. *

I understand

Have you ever had any injuries or chronic pain? *

Yes No

If yes, please explain below *

Have you ever had any surgeries? *

Yes No

If yes, please explain below *

Has a medical doctor ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes? *

Yes No

If yes, please explain below *

Are you currently taking any medication? *

Yes No

If yes, please explain below *

Is there any else you think i may need to know that may effect your ability to train. (this is of course in total confidence). *

Because physical exercise can be strenuous and subject to risk of serious injury, we urge you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity. You agree that by participating in physical exercise or training activities, you do so entirely at your own risk. Any recommendation for changes in diet including the use of food supplements, weight reduction and/or body building enhancement products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness, or death *

I Agree

By clicking ‘i agree’ & submitting this completed form, you confirm that you have read, understood and completed the par questionnaire and answered all questions truthfully, to the best of your knowledge. *

I Agree

Services

Small Group Personal Training
1:1 Personal Training
Nutrition Coaching
Online Personal Training

CLAIM YOUR TRIAL SESSION

Company

About
Blog

Support

Contact
Client Login

Address

The Armoury Coaching Studio LTD
Victory Ct
Third Ave
Bletchley
Milton Keynes
MK1 1EW

Website Design by My Personal Trainer Website

PARQ

YOUR Details

Readiness for Activity

Medical

Services

Company

Support

Address