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PAR-Q Form
We value your wellbeing and safety. Prior to your first class, we kindly request that you complete the PAR-Q form. Rest assured, all information provided will be treated as confidential and securely stored. Your health is important to us, and this form will help us better understand your specific needs and ensure a safe and enjoyable experience. Check out our website
www.100powerpilates.co.uk
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* Indicates required question
Your Full Name
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Your answer
Email
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Your answer
Contact number
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Your answer
Age
*
Your answer
Doctors surgery/Physicians Name and contact details
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Your answer
Emergency Contact Name
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Your answer
Emergency Contact phone number
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Your answer
Has your doctor ever said that you have heart condition and that you should only perform physical activity recommend by a doctor ?
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Yes
No
Other:
Do you feel pain in your chest when you perform physical activity ?
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Yes
No
Other:
In the past month, have you had chest pain when you were not performing any physical activity ?
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Yes
No
Other:
Do you lose your balance because of dizziness or do you ever lose consciousness ?
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Yes
No
Other:
Do you have bone or a joint problem that could be made worse by a change in your physical activity ?
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Yes
No
Other:
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition ?
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Yes
No
Other:
Do you know of any other reason why you should not engage in physical activity ?
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Yes
No
Other:
Are you pregnant or have you had a baby in the past 6 months ?
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Yes
No
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