WEIGHT LOSS AND PAR-Q FORM

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Email *

Name *

Phone *

Height *

Weight *

Age *

Goals *

Emergency contact name and phone number *

Interest *

Personal Training

Private Group Training

Nutrition and Wellness Counselling

Virtual Training

35 Minute Workout Program

Personalized work out program [8 weeks]

Mighty Minty Wellness Oil Blend

Other:

Required

Sex *

Male

Female

Fitness Level *

Low

Moderate

Active

Required

PAR Q FORM

Has your doctor diagnosed you with a heart disease?

Do you ever faint or have dizzy spells?

Do you take any medications on a regular basis

Do you suffer from any bone, muscle or joint pains?

Are you pregnant or have given birth in the last 6 months?

Do you know any reason you shouldn't participate in physical exercise?

Dietary restrictions *

None

Vegetarian

Vegan

Kosher

Gluten-free

Other:

How did you hear about STRENcardio? *

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