Request edit access
MARSHFIT Online Program PAR-Q
Before we start the program, please complete this form and submit it.
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Current Weight *
Goal Weight *
Phone Number
Questions
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.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy