Gym Training and Physical Activity Readiness Questionaire   First Name:  * Last Name:  * Email Address:  * Mobile Number:  * Date of Birth:  *   Physical Activity Readiness Questionnaire (PAR-Q)   Regular physical activity is fun & healthy and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However some people should check with their doctors before they start becoming much more physically active. If you are planning to become more physically active than you are now start by answering the seven questions below. If you are between the ages of 15 & 69 the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age and you are not used to being very active check with your doctor.   Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly. Tick YES or NO and all 7 questions must be answered.   1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? Yes No 2. Do you feel pain in your chest when you do physical activity? Yes No 3. In the past month have you had chest pain when you were doing physical activity? Yes No 4. Do you lose your balance because of dizziness or do you ever lose consciousness? Yes No 5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? Yes No 6. Is your doctor currently prescribing drugs (eg. water pills) for your blood pressure or heart condition? Yes No 7. Do you know of any other reason why you should not do physical activity? Yes No   If you answered YES to one or more questions Talk to your doctor by phone or in person BEFORE you start becoming physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and to which quesions you answered YES. * You may be able to do any activity you want - as long as you start slowly and build up gradually. Or you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice. * Find out which community programmes are safe and helpful.   If you answered NO to all questions If you answered NO honestly to all PAR-Q questions you can be reasonably sure that you can: * Start becoming much more physically active - begin slowly and build up gradually. This is the safest and easiest way to go * Take part in a fitness appraisal - this is an excellant way to determine your basic fitness so that you can plan the best way for you to live actively   Delay in becoming much more active * If you are not feeling well because of temporary illness such as cold or a fever - wait until you feel better. * If you are or may be pregnant - talk to your doctor before you start becoming more active.   Please Note: If your health changes so that you answer YES to any of the above questions tell your fitness or health professional. Ask whether you should change your physical activity plan.   Informed use of the PAR-Q: Massage-Etc and their agents assume no liability for persons who undertake physical activity and if in doubt after completing this questionnaire consult your doctor prior to physical activity. I have read understood and completed the questionnaire. Any questions I had were answered to my full satisfaction.   Full Name: Today's Date:   Client's expectations & reasons for training   What are your objectives: Training days per week required: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Training history: Body Type: Mesomorph Ectomorph Endomorph Measurements (please specify): Imperial eg: Pounds and inches Metric eg: Kilograms and centimetres Height: Weight: Extended Arm Length: Chest or Bust: Waist: Inside leg:   Diet & Nutrition   Do you follow a special diet eg: vegetarian vegan etc Yes No If Yes please specify:   Briefly describe your daily diet: Breakfast: Lunch: Dinner: Snacks:   On average how much of the following does your diet contain? - (servings per day) Fresh fruit & vegetables: 0 1 2 3 4 5 5 plus Wholefoods: 0 1 2 3 4 5 5 plus Dairy: 0 1 2 3 4 5 5 plus Protein: 0 1 2 3 4 5 5 plus Sugar: 0 1 2 3 4 5 5 plus Salty / Spicy foods: 0 1 2 3 4 5 5 plus   Your eating habits Which of the following meals do you eat on the go: Breakfast Lunch Dinner Snacks Binging: Yes No Over eating: Yes No Which meals do you regularly sit down to eat: Breakfast Lunch Dinner   Your drinking patterns Tea (cups per day): 0 1 2 3 4 4 plus Coffee (cups per day): 0 1 2 3 4 4 plus Herbal teas (cups per day): 0 1 2 3 4 4 plus Water (litres per day) 0 1 2 3 4 4 plus Fruit Juice (litres per day): 0 1 2 3 4 4 plus Other including sports supplements (please specify):   Your anti-nutrient intake Alcohol (number of units per week): Cigarettes (number per day): Recreational drugs:   Likes and Dislikes Which machine exercises do you enjoy?: Which free weights exercises do you enjoy?: Which CV equipment do you enjoy using?: Which exercises do you dislike totally?: Other likes and dislikes (please specify):   Additional information that we should know about:   Newsletter signup:   Check this box to signup for our newsletter keeping you informed of happenings and giving you access to savings on sports supplements and gym clothing.   Security code:   * Do not enter anything in this field:

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