Physical Activity Readiness Questionnaire
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Name: *
Age: *
Height: *
Weight: (If weight loss is not a primary goal of yours and you are not comfortable answering, feel free to leave blank!)
Contact info (cell and email): *
Has your doctor 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 perform physical activity? *
In the past month, have you had chest pain when you were not performing any physical activity? *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
Is your doctor 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 you have answered “Yes” to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered “Yes” to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. *
What is your current occupation? (or grade if under 18) *
Does your occupation require extended periods of sitting? *
Do your occupation/hobbies/sports require extended periods of repetitive movements? (If yes, please explain.) *
Does your occupation require you to wear shoes with a heel (dress shoes)? *
Does your occupation/school/sport cause you anxiety (mental stress)? If yes, tell me a little about it! *
Do you partake in any recreational activities (golf, tennis, skiing, etc.)? (If yes, please explain.) IF YOU ARE A SOFTBALL PLAYER - do you play any other sports? *
Do you have any hobbies (reading, gardening, working on cars, exploring the Internet, etc.)? (If yes, please explain.) SOFTBALL PLAYERS - What do you do for fun aside from sports? *
Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc.)?(If yes, please explain.) *
Have you ever had any surgeries? (If yes, please explain.) *
Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol or diabetes? (If yes, please explain.) *
Are you currently taking any medication? (If yes, please list.) *
Please describe your "why".  What is it that drives you to get fit? What does your healthiest version of yourself look like in your eyes?    SOFTBALL PLAYERS - What drives you to be the best player and athlete you can be? What would you consider success on and off the field? *
IF INTERESTED IN MOBILE SESSIONS ONLY: What, if any, equipment do you already have at home or will have access to? *
How many days a week can you commit to? (Remember... meet yourself where you're at and start at a sustainable pace!) *
Now lets plan it out... How many weeks will we agree to follow the above days per week to start? *
For softball players: Do you have hopes of playing College Softball? Is that something you have thought about? Are you actively trying to be recruited by college coaches? *
Tell me one thing you absolutely LOVE about yourself or your body :) *
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