Physical Activity Readiness Questionnaire (PAR-Q)

Please fill out the following form.

Emergency Contact Name and Tel Number:

Medical History

There are many health benefits to be gained from regular physical activity, however there are some safety factors to consider before increasing your level of activity.  It may be necessary to seek medical advice from your doctor before beginning a new exercise programme.

If you need any clarification, or have any questions, please ask your instructor.

Please answer the following questions:

Have you ever been diagnosed with any of the following medical conditions?

Have you suffered any of the following:

Do you ever experience chest pain during physical activity?

In the last month, have you experienced any chest pain whilst not physically active?

Do you suffer with any joint or bone conditions (including spinal problems) that might be made worse by physical activity?

Are you taking any prescribed medication?

Are you pregnant, or have you given birth in the last three months?

Have you had surgery within the last 3 years?

If you answered yes to any of the medical questions (1-9) your instructor may defer your session until written medical clearance is provided by your doctor.

Past History and Future Goals

Please indicate how long it has been since you regularly exercised (minimum of 3x30 minutes per week)

What environment was that in? (PT/Gym/Classes/Cardio)

Please indicate your reasons for exercising (select all that apply):

Please expand on why these reasons are important to you:

Do you have a specific goal in mind?

Are there any particular exercises you dislike?

How many days per week would you like to train?

What might prevent you from achieving your goals? (work/home commitments etc)

Please read and sign to say that you agree with the following statement:

I confirm that I have correctly answered all of the above questions honestly to the best of my knowledge & release CG Strength and Fitness from any liability with respect to any damage or injury which I may suffer whilst exercising. I know of no reason why I should not exercise and confirm that I take part of my own free will. I understand that I should only exercise when I feel well and that I must notify my trainer of any changes in my health.