Physical Activity Readiness Questionnaire (PAR-Q) & Survey

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First and Last Name *

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

Yes

Do you feel pain in your chest when you do physical activity?
*

Yes

Do you lose your balance because of dizziness or do you ever lose consciousness?
*

Yes

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

Yes

Have you ever been diagnosed with a chronic condition such as heart disease or high blood pressure? If not, write no. *

Has your doctor ever said you should only do medically supervised physical activity? *

Yes

Are you currently taking any prescribed medications for a chronic medical condition? If not , write no *

Do you know of any other reason why you should not do physical activity? If not, write no
*

What are your Health/Fitness Goals? *

What are you doing at the moment to reach those goals? *

What are some barriers that would prevent you from achieving your goals? (Work, lack of motivation, etc.) *

What physical activity have you done in the past? *

Have you ever had a trainer previously? If so, what did you like and dislike about their training style? *

What do you typically eat throughout breakfast, lunch, snack and dinner? How much water do you drink? *

Are you taking any vitamins and/or supplements? If so, what are they? *

What is the most important thing I can do for you? *

Rank these on a scale from 1-5. Number 1 being least important and number 5 being most important

Weight Loss, Muscle Gain, Strength Gain, Mobility and Stability Improvement, and Postural Improvement

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