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MARSHFIT Online Program PAR-Q
Before we start the program, please complete this form and submit it.
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Email *
Full Name *
Date of Birth *
Current Weight *
Goal Weight *
Phone Number
If you answer Yes to ANY of the questions below, please consult your GP before engaging in this program.
Has your GP ever said that you have a Heart Condition and that you should ONLY perform physical activity recommended by a Doctor? *
Do you feel pain in your chest when you before physical activity? *
In the past month, have you had chest pains when you are NOT performing any physical activity? *
Do you lose balance because of dizziness OR do you ever lose consciousness? *
Do you have any bone OR joint problems that could be made worse by a change in your physical activity? *
Is your GP currently prescribing ANY medication for your blood pressure OR for a heart condition? *
Do you know of any other reason why you should not engage in physical activity? *
If yes to ANY above, please state below. If NO to all, please state NONE. *
What are your main goal for participating in this program? *
A copy of your responses will be emailed to the address you provided.
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