PAR-Q

Please complete this brief health screening to ensure safe and effective training.

First name

Last name

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

Yes

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

Yes

In the past month, have you had chest pain when you were not doing physical activity?*

Yes

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

Yes

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

Yes

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*

Yes

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

Yes

Do you have any injuries or medical conditions your trainer should be aware of? *

Yes

If yes, please explain

I have honestly answered the above questions. I understand that I should consult my doctor before beginning any exercise program if I answered YES to any of the questions above.

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JOE NGUYEN —
CERTIFIED FITNESS TRAINER

Helping you rewrite your story through strength and resilience.

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