Aphrodite Fitness Pre/Post Natal- Leah Fowler
Physical Activity Readiness Questionnaire (PAR Q)

This form is to assess your suitability to take part in physical exercise voluntarily, this in no way represents a legal responsibility for Leah Fowler, or any persons employed by Aphrodite Fitness, for any situation that arises from you taking part in physical exercise.

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Name *
Date of Birth *
MM
/
DD
/
YYYY
Address
Postcode
Email *
Phone Number *
Emergency Contact - Name & Number *
Please select all that apply to you, if you select any, please add detail in the last box.
Please outline your recent exercise history. *
Date of delivery / gestation stage *
Type of delivery *
Required
Episiotomy? *
Required
Are you breast feeding?
Clear selection
Have you been signed off to exercise by your GP, at your 8 week check? *
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