PAR-Q

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PAR-Q

This is a health questionnaire that we require you to fill out ahead of the trial session. Please take your time filling this out.

Email *

Your Details

Full Name *

Age *

How we can contact you

Contact Number *

Address *

Emergency Contact Full Name *

Emergency Contact Phone Number *

What we need to know before we get started...

Q1: Has your Doctor ever said you've had a heart problem?* *

Yes

If Yes, Please explain more

Q2: In the past month, have you have any chest pains?* *

Yes, when doing activity

Yes, when resting

If Yes, Please explain more

Q3: Have you ever been diagnosed with any of the following; a) High or Low Blood Pressure b) Osteoarthritis c) Diabetes d) Eating disorder e) Asthma, bronchitis any other breathing or respiratory illness: f) Cancer g) Heart diseases h) Rheumatoid Arthritis i) Stroke j) Epilepsy k) Other problems* *

Yes

If Yes, Please explain more

Q4: Have any, or are any, of your immediate family (Grand Parents , Parents, Sibling or aunt/uncles) suffering from any of the following; a) High or Low Blood Pressure: b) Osteoarthritis: c) Diabetes: d) Eating disorder: e) Asthma, bronchitis any other breathing or respiratory illness: f) Cancer: g) Heart diseases: h) Rheumatoid Arthritis: i) Stroke : j) Epilepsy: k) Other problems:* *

Yes

If Yes, Please explain more

Q5: Do you suffer from any bone or joint problems?* *

Yes

If Yes, Please explain more

Q6: Do you ever feel any pain in your muscles?* *

Yes

If Yes, Please explain more

Q7: Do you suffer from excessive fatigue or tiredness?* *

Yes

If Yes, Please explain more

Q8: Do you ever… lose your balance because of dizziness or lose consciousness* *

Yes

If Yes, Please explain more

Q9: Are you Pregnant?* *

Yes

Q10: Have you recently had a baby?* *

Yes

If Yes, Please explain more

Q11: Are you feeling unwell at present due to cold, etc* *

Yes

If Yes, Please explain more

Q12: Have you recently had any surgery or been admitted into hospital?* *

Yes

If Yes, Please explain more

Q13: Are you currently taking any medication?* *

Yes

If Yes, Please give more details of medications we should be aware of

Q14: Have you seen your Doctor in the last 6 Months?* *

Yes

If Yes, Please explain more

Digital Declaration

I have read, understood and completed this questionnaire to the best of my Knowledge. Any questions that I have answered are to my full satisfaction.* *

Yes

I understand if I have answered YES to any of the above questions it is my duty to consult my doctor/ physician prior to getting started with my training with the Metabolic Fitness Team.* *

Yes

If my circumstances change so that any of my answers to the questions above are affected I will notify a member of the Metabolic Fitness Team.* *

Yes

Send me a copy of my responses.

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