PARQ Form

Please fill in the form below to complete your sign up to our fitness centre

Date of Birth?(Required)

Have you ever suffered from any of the following?

Diabetes?(Required)
Epilepsy?(Required)
High Blood Pressure?(Required)
Asthma?(Required)
Heart Problems?(Required)

Have you ever had the following?

Back or neck pain?(Required)
Serious joint injuries?(Required)
Have you had a medical before?(Required)
Blackouts?(Required)
Do you smoke?(Required)
Are you pregnant?(Required)
Are you on medication?(Required)
Have you ever had a serious illness or operation in the past?(Required)
Do you currently exercise?(Required)
Do you drink alcohol?(Required)
Is your diet balanced?(Required)
What time do you normally train or attend classes?(Required)
:
Would you be interested in hiring a personal trainer?(Required)
Would you be interested in online coaching?(Required)
Consent(Required)
Reset signature Signature locked. Reset to sign again
MM slash DD slash YYYY