Physical Activity Readiness Questionnaire

To participate in on-line fitness training (also known as virtual training) or in-person fitness training you are required to complete the physical activity readiness questionnaire.

A Physical Activity Readiness Questionnaire (also called a PAR-Q) is used in the health & fitness industry to screen for risk factories during physical activities. Any risk factors must be cleared by your physician in order to healthcare provider before you can participate with on-line or in-person fitness training. If you have any questions about potential risk factors please contact or schedule an appointment with your doctor or healthcare provider. If you need assistance on answering the questionnaire please advise with your doctor or healthcare provider.

Client Assessment Form

Confidential – For internal use only.

*First Name:
*Last Name:
*Address:

*City:
*State:
*Zip:

*Email:

*Main Phone:
Area Code: ( ) Phone:

Alt. Phone:
Area Code: ( ) Phone:

THIS AFFECTS HEART RATE LEVELS
*Biological Sex:

*Birth Date:
Relationship:

*Children Under Ten:

*Children Over Ten:

*Height:

EMERGENCY CONTACT INFORMATION
*Full Name:
*Phone:

I hereby certify that the information I am submitting in this form is correct.
*Digital Signature:
Type your full name, please. Thank you.

*Today's Date:

Confidential – For internal use only.

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Client Assessment Form