BE AWESOME BE STRONG LLC - HEALTH HISTORY & PAR-Q INTAKE FORM



PRE-PARTICIPATION SCREENING QUESTIONNAIRE * Assess your health status by marking all true statements 

Please note if your health changes please tell you health care provider and notify us. Be Awesome Be Strong LLC and Beth Anne Moonstone assume no liability for persons who undertake physical activity, and if after completing this questionnaire you have concerns please consult your doctor. This physical activity clearance is good for 12 months from the date completed.


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History 

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Any other health concerns you'd like us to be aware of?  *
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date *
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I have complete this form to the best of my ability and understand these clearance questions.  *
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