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PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

CONFIDENTIALITY NOTICE: ALL OF YOUR INFORMATION IS SECURED, CONFIDENTIAL AND WILL NEVER BE SHARED WITH ANYBODY. This data helps DannyTheCoach to formulate a plan of action.

DEMOGRAPHIC DATA

* Indicates required field

Name *

First

Last

Email *

QUESTIONS - All questions are required.

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

Yes No

Do you feel pain in your chest when you perform physical activity? *

Yes No

In the past month, have you had chest pain when you are not performing any physical activity? *

Yes No

Do you lose your balance because of dizziness or do you ever lose consciousness? *

Yes No

Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

Yes No

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

Yes No

Do you know of any other reason why you should not engage in physical activity? *

Yes No

If yes, please explain here: *

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NOTE: If you have answered YES to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered YES to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. We can then discuss what the best approach is for your fitness training.

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Home
Services
About
- Testimonials
- Video Library
Updates
- Update Index
Contact

PAR-q fORM

PHYSICAL ACTIVITY READINESS QUESTIONNAIRECONFIDENTIALITY NOTICE: ALL OF YOUR INFORMATION IS SECURED, CONFIDENTIAL AND WILL NEVER BE SHARED WITH ANYBODY. This data helps DannyTheCoach to formulate a plan of action.

Who we are

What we do

How to contact

Want Us to Contact You?

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

CONFIDENTIALITY NOTICE: ALL OF YOUR INFORMATION IS SECURED, CONFIDENTIAL AND WILL NEVER BE SHARED WITH ANYBODY. This data helps DannyTheCoach to formulate a plan of action.