Health screening and consultation questions

Please fill out the form below:

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Contact number

Emergency contact name

Emergency contact number

PARQ (pre activity readiness questionnaire) There are 7 health screening questions below.If you’re aged 15-69, the 7 questions below will tell you if you should check with your doctor before significantly changing your physical activity patterns. If you’re over 69 years and aren’t used to being very active, check with your doctor. Please read each question carefully and answer honestly by selecting YES/NO

1) Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?

2) 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 balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem that could be made worse by a change in your 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 take part in physical activity?

If yes to any of the above please provide more information

If you answered YES to one or more questions: You should consult with your doctor to clarify that it’s safe for you to become physically active at the current time. If you answered NO to ALL of the questions: It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. Now onto the consultation questions below:

What are your reasons/goals for wanting personal training?

What is your past/current excercise experience/level, if none just say none.

Do you have any health issues or smaller niggles, pains, weaknesses, past common injuries, soreness, tightness etc other than anything covered on the 7 questions at the top?

Is your general day to day life/job sedentary or active?

What is your best time and days to train?

What is your current diet like, you don’t have to be too specific as we will look at this more in the future.

Do you smoke or vape. Do you drink alcohol, if so how much?

Any other comments or questions?

CONSENT AND SIGNITURE I have read, understood and completed the PAQR 7 health screening questions a the top. All questions have been answered to the best of my knowledge. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury. I agree to take part in the program described to me by my trainer. I understand that I may withdraw at any time. I release Tom Higgins, Hybrid Endurance and any of its personal trainers, employees and any person associated with Hybrid Endurance from any liability for any injury or illness that I may suffer during an exercise session or subsequently occurring in connection with the exercise session or to any extent the session contributed to it. ELECTRONIC SIGNITURE - By typing your name below you are in effect signing this form.

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