PT PAR-Q

Name *

First

Last

Contact No. *

Email *

Occupation *

D.O.B *

On a scale of 1-10, how important are these goals to you? *

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

pt & vpt PAR-Q

pre-exercise questionnaire