PARQ - Strength Coach Glasgow

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Physical Activity Readiness
Questionnaire

Personal Information

* Indicates required field

Name *

First

Last

Email *

Contact Number *

Date of Birth *

Address *

Emergency contact

Name *

Relation *

Contact Number *

Pre-Exercise Questionnaire

Do you have or have you had any of the following?

Heart Disease or any other Cardio Vascular condition? *

Yes No

High Blood Pressure? *

Yes No

Any History or coronary heart disease in your family? *

Yes No

A major Illness or surgery in last 5 years? *

Yes No

Diabetes? *

Yes No

Do you smoke? *

Yes No

Arthritis or other joint/muscular pain? *

Yes No

Asthma or difficulty breathing? *

Yes No

Epilepsy? *

Yes No

Dizziness, blackouts or fainting spells? *

Yes No

Are there any other conditions or medical problems which may be reasons to modify your exercise program? *

If you have said YES to any of the above, you need a signed medical clearance from your doctor before starting exercise.

By ticking this box I warrant that I am physically and mentally well enough to proceed with usage of the facility. *

Yes

I agree to receiving marketing and promotional materials

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@ The Muthaship
124 Portman Street
Glasgow, G41 1EJ

Strength Coach Glasgow

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Home
About
Programs
Success Stories
Contact
Blog

Physical Activity Readiness Questionnaire

Personal Information

Emergency contact

Pre-Exercise Questionnaire

Services

Learn More

Support

Address

Physical Activity Readiness
Questionnaire