About You

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Age
Occupation
Height
Weight

PAR-Q FORM

Please answer YES or No to the following:
1. Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?YesNo
2. Do you feel pain in your chest when you perform physical activity?YesNo
3. Have you had chest pain when you were not doing physical activity?YesNo
4. Do you lose your balance due to dizziness or do you ever lose consciousness?YesNo
5. Do you have a bone, joint or any other health problem that causes you pain or limitations during physical activity?YesNo
6. Are you pregnant or have you given birth within the last 6 months?YesNo
7. Have you had surgery recently?YesNo
8. Do you take any medications, either prescription or non-prescription, on a regular basis? If so, what is the medication for?YesNo
9. How does this medication affect your ability to exercise or achieve your fitness goals?YesNo

If you have marked YES to any of the above, please talk with your doctor before you start your fitness programme.

Please note: If your health changes so that you answer any of the above questions YES, please inform your Doctor and ask whether you should change your physical activity plan.

Lifestyle Related Questions (Spaces to fill in answer)

1. Do you smoke? If yes, how many per week?
2. Do you drink alcohol? If yes, how many units per week?
3. How many hours do you sleep per night?
4. On a scale of 1-10, how would you rate your present fitness level (1=Poor - 10= Good)?
5. Have you attempted to get fit, lose weight, get toned or build muscle in the past? If so, what were the results and what did you do to achieve this? And did you maintain the results? And if not why not?
6. When were you happiest with your shape or body?
7. Have you ever been a member of a gym, fitness club, Or have had a personal trainer or online coach in the past?
8. How many times per week will you be able to train?
9. What are your Goals? (Tick the box)Fat/Weight LossMore Lean Muscle Upcoming Special Occasion BodybuildingIncrease energy levelsLook/Feel good about yourselfHealthier lifestyleOther. Please specify
10. Is there any area on your body that you would like to emphasise on?
11. Anything else you would like to mention?

Nutrition Related Questions

1. Do you feel drops in your energy levels throughout the day? If yes, when?
2. Are you currently taking any food supplements? If yes, please list the supplements
3. What are your diet downfalls/weaknesses?
4. Are there any foods you dislike? Please list the foods:
5. Do you have any food allergies? Please list the foods:

Your Message