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 address *
Your Details
Full Name *
Your answer
Age *
Your answer
How we can contact you
Contact Number *
Your answer
Address *
Your answer
Emergency Contact Full Name *
Your answer
Emergency Contact Phone Number *
Your answer
What we need to know before we get started...
Q1: Has your Doctor ever said you've had a heart problem?* *
If Yes, Please explain more
Your answer
Q2: In the past month, have you have any chest pains?* *
If Yes, Please explain more
Your answer
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* *
If Yes, Please explain more
Your answer
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:* *
If Yes, Please explain more
Your answer
Q5: Do you suffer from any bone or joint problems?* *
If Yes, Please explain more
Your answer
Q6: Do you ever feel any pain in your muscles?* *
If Yes, Please explain more
Your answer
Q7: Do you suffer from excessive fatigue or tiredness?* *
If Yes, Please explain more
Your answer
Q8: Do you ever… lose your balance because of dizziness or lose consciousness* *
If Yes, Please explain more
Your answer
Q9: Are you Pregnant?* *
Q10: Have you recently had a baby?* *
If Yes, Please explain more
Your answer
Q11: Are you feeling unwell at present due to cold, etc* *
If Yes, Please explain more
Your answer
Q12: Have you recently had any surgery or been admitted into hospital?* *
If Yes, Please explain more
Your answer
Q13: Are you currently taking any medication?* *
If Yes, Please give more details of medications we should be aware of
Your answer
Q14: Have you seen your Doctor in the last 6 Months?* *
If Yes, Please explain more
Your answer
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.* *
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.* *
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.* *
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