PAR-Q FORM

Name*

First Last

Do you smoke?*

Any injuries?*

Current fitness level?*

Have you ever been told by a medical professional not to exercise?*

Please give details.*

Do you ever experience back pain?*

Please provide more details.*

Please list ALL exercise kit you have access to, if none state NONE.*

What device will you be using for our sessions?*

In the event of an emergency please provide a name and number I can contact for you.*

Please let me know your full address.*

Anything else you think I should know?*