PARQ - LL Fitness

Physical Activity Readiness Questionnaire

Full Name

Date of Birth

Email Address

Telephone Number

Address

Emergency Contact Name

Emergency Contact Number

Please take time to complete this questionnaire as fully as possible. If you have any questions or are not clear on anything being asked please contact me. Your information will be held in a secure place and only referred to by me.

Has your doctor ever said that you have a heart condition and you should only do physical activity recommended by a doctor?

YesNo

Have you ever had a heart surgery procedure?

YesNo

Do you experience chest pain when you do physical activity?

YesNo

Do you experience chest pain at rest? Or have done so in the past?

YesNo

Do you experience severe dizziness, fainting or blackouts?

YesNo

Are you taking any prescription medication?

YesNo

Are you taking any non-prescribed medications?

YesNo

Do you have epilepsy?

YesNo

Do you have type I or type II diabetes mellitus?

YesNo

Do you have asthma or any other chest condition?

YesNo

Have you had any surgery in the past 6 months?

YesNo

Are you pregnant, reason to believe you may be pregnant or have you been pregnant in the past 6 weeks?

YesNo

Do you have any muscle, bone or joint problems?

YesNo

Are you unused to physical activity?

YesNo

Do you have high blood pressure? If yes what was your last readout?

YesNo

Do you smoke? Or have you smoked in the previous 6 months?

YesNo

Are you aware of any other reason that would prevent you from doing physical activity without medical supervision?

YesNo

If you answered YES to one or more of the questions:
- A medical referral maybe required before physical activity can commence.
- If you answered YES to 2 or more questions then your initial training intensity maybe restricted to moderate.

If you answered NO to all the questions:
If you answered NO go all PAR-Q questions then you can be reasonably assured that you can:
- Start to become more physically active.
- Take part in a fitness appraisal. Talk to your trainer.

DECLARATION

I wish to embark on any physical activity with LL Fitness that includes weight training, aerobic conditioning and the equipment provided by LL Fitness. I hereby confirm that I do not suffer from any form of condition which prevents my participation in any exercise program.

I hereby release LL Fitness, its employees and owners from any claims, demands and cause of action arising from my participation in this exercise program. I agree to abide by the conditions of use as stated in this document.

I fully understand that should I injure myself as a result of exercise participation, that I hereby release LL Fitness from any liability now or in the future.

I agree to these terms, and content to personal data storage, as outlined in the Privacy Policy (your data is safe with us, it will not be shared, sold, given to any third-party or used unlawfully).

Get in touch

Get in touch for a FREE consultation or for more information about how we can help you achieve your fitness goals.

Lyndsay Lee
Personal Trainer and Fitness Instructor
lyndsay@llfitness.co.uk
07979 756 699