PARQ

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PARQ

Certain medical issues may indicate that you should not take part in exercise unless you have first obtained your doctor’s approval.

#1 Do you suffer from a heart condition ? *

#2 Do you feel pain in your chest when you do physical activity? *

#3 Do you lose balance because of dizziness or do you ever lose consciousness?

#4 Have you ever been diagnosed with osteoporosis or osteoarthritis ? *

#5 Is your doctor currently prescribing any medication for your blood pressure or a heart condition? *

#6 Is there any family history of heart disease, stroke, raised cholesterol or high blood pressure? *

#7 Do you suffer from diabetes/epilepsy/asthma? *

#8 Have you ever had any problems with your back? *

Next of Kin *

Next of Kin Phone Number *

Declaration

If you have any questions regarding this Pre Exercise Questionnaire please speak to your personal trainer. If any of your answers to the above questions changed or for any reasons you are unsure at any time, whether as a result of state of health you should exercise please seek the approval of your doctor and inform you personal trainer before exercising.
I have read and fully understand this "Pre Exercise Questionnaire" and confirm that the answers given by me are correct and not misleading. Further more I understand its my responsibility to inform my personal trainer if my health status changes.

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I fully read the above and confirm

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