Physical Activity Readiness (PAR-Q)
Next of Kin
Phone contact details
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had a chest pain when you were not doing physical activity?
Do you lose you balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem (for example, back, knee, hip) that could be made worse by a change in your physical activity?
Do you suffer from any social or behavioural issues due to neurological diverse conditions such as Autism, Attention Deficit, Bipolar or Aspergers Syndrome?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Are you currently taking any regular form of medication?
Do you know of any other reason why you should not do physical activity?
If you have answered YES to one or more of the above questions please comment:
I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.
Having answered YES to one of the above, I have sought medical advice and my GP has agreed that I may exercise.
Getting to know you
How YOU can make the most of GRAVITY
How many days a week do you take part in sport or physical activity?
Your favourite type of exercise is?
Are you a 3000, 7000, 10000, or 14000+ steps a day person?
How would you rate your motivation to exercise on a scale of 1-10 (1=lowest, 10=highest)
What is your favourite type of music to exercise to?
Which goals do you have? Tick up to 3 which are most important to you
A more toned body
Rehab an injury
Become better at sport
A flatter stomach
Better self esteem
A stronger lower body
A stronger upper body
Make fitness a habit
Training for an event
Better social contact
Clothes fit again
A stronger core
What's most important to you in life?
How would you rate your willpower on a scale of 1-10 (1=lowest, 10=highest)
What do you do for a living?
What are your average hours of sleep per night?
How energetic do you generally feel on a scale of 1-10 (1=lowest, 10=highest)
Your favourite type of activity other than exercise is?
What are the best days for you to come to the GRAVITY studio? Mon, Tues, Weds, Thu, Fri, Sat, Sun
What’s the best time for you to come to the GRAVITY studio: early am, mid am, lunch, early evening, later evening?
Anything else you think we should know
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm
Copyright 2018 JotForm Inc.