F45 Greatwood PAR-Q Form

Physical Activity Readiness Questionnaire
Information to help us to best help you
Full Name*
First NameLast Name
Gender*
Height*
Age*
Weight*
Please read the following questions carefully and check (X) next to the appropriate answers. Answer all questions honestly and to the best of your ability.

YES/ NO*

	Yes	No
Has your doctor ever said that you have a heart condition (had a stroke, heart attack, or heart surgery) and/ or 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 chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Have you ever been told by a doctor that you have bone, joint, or muscle problems that could be made worse by physical activity?
Do you have a diagnosed illness that could be made worse by physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

1. What are your top 2 goals?*
2. How would you rate your current nutrition? *

1 2 3 4 5 6 7 8 9 10
1 is Worst, 10 is Best
3. How would you rate your current fitness level? *

1 2 3 4 5 6 7 8 9 10
1 is Worst, 10 is Best
4. How can we best help you meet your goals?*
5. What is your current occupation?*
6. Does your occupation require extended periods of sitting?*
7. Does your occupation require extended periods of repetitive movements? (If yes, please explain)*
8. Does your occupation require you to wear shoes with a heel?*
9. Does your occupation cause you anxiety (Mental Stress)?*
10. Do you participate in any recreational activities (golf, tennis, skiing, etc)? (if yes, please explain.) *
11. Do have any hobbies (reading, gardening, working on cars, etc.) (if yes, please explain.) *
12. Have you ever had any pain or injuries? (ankle, knee, hip, back, shoulder, etc.) (if yes, please explain.) *
13. Have you ever had any surgeries? (if yes, please explain.)*
14. Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol or diabetes? (If yes, Please list below)*
15. Are you currently on any medication? (If yes, please list)*
Fitness Participation Agreement
I have voluntarily chosen to participate in F45 Classes at F45 Training Greatwood. I have answered the questions above to the best of my ability and affirm that my physical condition is good and I have no known conditions that would prevent me from participation. I acknowledge that participation is at my own pace and comfort level and that I may discontinue my participation at any time. Furthermore, I agree to self-determine my exertion through good judgement and to discontinue any activity that exceeds my personal limitations. I understand that by signing this agreement that I hereby waive and release F45 Training Greatwood, staff, and all relevant employees in any way from liabilities or demands as a result of injury, loss, or adverse health conditions as a result of my participation. I affirm that I have read and understand ths document and I wish to participate in fitness activities.
Signature of Participant:*
Clear
Type name of Participant*
Date*
MonthDayYear
Should be Empty:

Physical Activity Readiness Questionnaire