Pre Activity Readiness Questionnaire

    Name (required)

    Address (required)

    Phone Number (required)

    Email Address (required)

    Emergency Contact Name and Number (required)

    Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly.

    1. Has your Doctor ever said you should NOT take part in physical activity? YesNo

    2. Has your Doctor ever said that you have a heart condition? YesNo

    3. Has your Doctor ever said that you have high/low blood pressure? YesNo

    4. Are you taking any medication for your blood pressure or heart condition? YesNo

    5. Do you have Diabetes Mellitus or any other form of Diabetes? YesNo

    6. Do you, or have you recently felt pain in your chest when doing physical activity? YesNo

    7. Do you ever lose balance, become dizzy or ever lose consciousness? YesNo

    8. Do you have any injuries that could be aggravated by exercise? YesNo

    9. More specifically, do you have any joint problems including back, knees and/or neck? YesNo

    10. Has anyone in your immediate family had a heart attack prior to the age of 55 years? YesNo

    11. Has your Doctor ever said you have raised cholesterol levels? YesNo

    12. Have you ever been short of breath, had difficulty breathing or been diagnosed with asthma? YesNo

    13. Do you suffer from Epilepsy? YesNo

    14. Are you or do you think you may be, pregnant? YesNo

    15. Have you had or are you in recovery from any major surgery including pregnancy in the last 6 months?
      If yes please give details below. YesNo

    Is there any other reason, medical or otherwise that may affect your ability to exercise?If yes, please comment below

     If you have answered YES to one or more questions: Talk with your doctor by phone or in person before you start becoming much more active, or before you have a fitness appraisal. Tell your doctor about the Pre Activity Readiness Questionnaire and which to questions you answered YES.

    Please note: If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical plan.

    We strongly advise that if you have not participated in regular physical exercise prior to beginning this activity, you should seek advice from your doctor

    Terms and Conditions


    Cancellation Policy: A 24 hour cancellation policy applies to scheduled sessions. Sessions cancelled or rearranged less than 24 hours in advance will be charged in full to the client. If a session is cancelled within 24 hours by the personal trainer, a complimentary session will be offered. All packages are non-refundable and must be taken within 20 weeks of payment.

    Bank Holidays: Sessions will not take place on a bank holiday or the weekend of a bank holiday. If a training session falls on a bank holiday then the session will be rescheduled at the convenience of both the client and trainer, or “rolled over” to the end of the current package.

    Statement

    I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities, which may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me, and that I should consult my doctor if I am suffering from any condition that might make physical activity injurious to my health. I understand that the responsibility of my fitness to participate rests with me. I agree to abide by any verbal or written instruction given by my trainer. I declare that to the best of my knowledge this information is correct and that I will notify my trainer of any changes in my medical condition.

    I Agree to Terms and Conditions

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