CTG @ STARKS FITNESS
Testimonials
Team
Contact us
Client Access
PT PAR-Q
CTG @ STARKS FITNESS
Testimonials
Team
Contact us
Client Access
PT PAR-Q
pt & vpt PAR-Q
Name
*
First
Last
Contact No.
*
Email
*
Occupation
*
D.O.B
*
What is your GOAL?
*
Fat Loss
Muscle Tone
Muscle Gain
Increase my CV fitness
Sport Related
On a scale of 1-10, how important are these goals to you?
*
10 = Very Important
9
8
7
6
5 = It's on my to do list!
4
3
2
1 = It's on my bucket list!
What is your ideal time to train?
*
Have you joined a gym before?
*
Yes
No
If yes, please specify how long have you been using a gym for?
*
On a weekly basis, how frequently do you or plan to exercise?
*
1-2
2-3
3+
When you exercise or plan to exercise, how long will it be intended for?
*
30 minutes
45 minutes
60 minutes
What are the barriers that may prevent you from reaching your goal? (Heavy work load, time management, lack of motivation, etc.)
*
Have you had a Personal Trainer before?
*
Yes
No
pre-exercise questionnaire
Do you currently or have you ever suffered from any of the following:
*
Indicates required field
Heart disease or chest pain?
*
Yes
No
Is there any history of heart disease in the family?
*
Yes
No
High Blood Pressure?
*
Yes
No
Do you suffer from diabetes?
*
Yes
No
Cholesterol Problems?
*
Yes
No
Are you currently taking medication?
*
Yes
No
If yes, please state below.
*
Please tick if applicable to you.
*
Acute Asthma
Epilepsy
N/A
Back pain that could be made worse by a change in physical activity?
*
Yes
No
Bone or joint problems that may be aggravated by exercise?
*
Yes
No
Allergies?
*
Yes
No
If Yes, please state below.
*
Have you had any major operations or illnesses?
*
Yes
No
Are you pregnant or post-natal?
*
Yes
No
Do you smoke?
*
Yes
No
If yes, how many per day?
*
Do you have any disabilities or any reasons not stated above why you should not participate in exercise?
*
Yes
No
Please state below any other information you would like to add before we proceed!
*
Who would you like to book with?
*
Charlie
Mercedes
Charlie (Facetime for Virtual Personal Training)
By submitting this form, I understand and agree to
'Terms & Conditions'
before partaking in exercise with Charlie's Training Group or Mercedes Personal Training.
Submit