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    REPs Members Lifestyle Questionnaire 2014 Long

    Uploaded by

    Lord Daen
    This document contains a physical activity readiness questionnaire (PAR-Q) that collects personal and medical information from a client in order to assess their readiness for exercise and identify any health risks. It asks about the client's contact details, health goals, exercise history and preferences, diet, lifestyle, medical conditions, and symptoms experienced. The client must sign to confirm they answered honestly and correctly.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    REPs Members Lifestyle Questionnaire 2014 Long

    Uploaded by

    Lord Daen
    349 views3 pages
    This document contains a physical activity readiness questionnaire (PAR-Q) that collects personal and medical information from a client in order to assess their readiness for exercise and identify any health risks. It asks about the client's contact details, health goals, exercise history and preferences, diet, lifestyle, medical conditions, and symptoms experienced. The client must sign to confirm they answered honestly and correctly.

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    REPs Members Lifestyle Questionnaire 2014 Long

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    This document contains a physical activity readiness questionnaire (PAR-Q) that collects personal and medical information from a client in order to assess their readiness for exercise and identify any health risks. It asks about the client's contact details, health goals, exercise history and preferences, diet, lifestyle, medical conditions, and symptoms experienced. The client must sign to confirm they answered honestly and correctly.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    349 views3 pages

    REPs Members Lifestyle Questionnaire 2014 Long

    Uploaded by

    Lord Daen
    This document contains a physical activity readiness questionnaire (PAR-Q) that collects personal and medical information from a client in order to assess their readiness for exercise and identify any health risks. It asks about the client's contact details, health goals, exercise history and preferences, diet, lifestyle, medical conditions, and symptoms experienced. The client must sign to confirm they answered honestly and correctly.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Physical Activity Readiness

    Questionnaire (PAR Q)
    Long version

    Your Personal Details


    Client Name:

    DoB:

    Address:

    Postcode:
    Email: Phone:

    Emergency Contact Details


    Name:
    Address:

    Postcode:
    Email: Phone:

    Your Health Goals


    1. What health goals would you like to achieve in the next 3 months?

    2. Name 3 things you could do in order to improve your health?

    What are your main reasons for starting a fitness programme?


    General conditioning

    Muscular strength
    Aerobic fitness

    No time

    Weight /fat loss

    Stress management

    Flexibility

    Other

    How would you describe your general health and fitness?

    Have you ever done any structured exercise?


    If Yes what did you do?
    What type of exercise do you enjoy the most?
    What type of exercise do you dislike the most?

    Yes / No

    Appearance
    Improve self-esteem

    Physical Activity Readiness


    Questionnaire (PAR Q)
    Long version

    What would you say are the main barriers preventing you from exercising?
    Lack of facilities
    Injury/illness
    Lack of knowledge

    No motivation

    Unfit

    Family

    No time

    Appearance

    Work

    Diet and Nutrition


    On a scale of 1-10 (with 1 being poor and 10 being excellent) how would you assess the quality of your eating habits?
    Would you like any help or advice in changing the quality of your eating habits?

    Yes / No

    Do you follow any particular diet or eating patterns?


    Lifestyle
    Do you drink alcohol?

    Yes / No

    Do you smoke?

    Yes / No

    If you answered Yes, would you like help or advice to change these habits?

    Yes / No

    Medical History
    Have you had a major illness or injury in the last 5 years

    Yes / No

    If Yes please give details

    Are you receiving treatment for any diagnosed medical condition?

    Yes / No

    If Yes please give details

    Are you taking any prescription medication?

    Yes / No

    If Yes please give details

    Please indicate if you ever experience any of the following symptoms. Do you:
    Ever get unusually short of breath with very light exertion?

    Ever have pain, pressure, heaviness or tightness in the chest area?

    Regularly have unexplained pain in the abdomen, shoulders or arm?

    Physical Activity Readiness


    Questionnaire (PAR Q)
    Long version

    Please indicate if you ever experience any of the following symptoms. Do you:
    Ever have severe dizzy spells or episodes of fainting?

    Regularly get lower leg pain during walking that is relieved by rest?

    Ever experience palpitations or irregular heartbeats?

    Are you currently pregnant or have you given birth in the last 6 months?

    Yes / No

    Structural Health
    Please indicate on the figures below any aches, pains or problem areas.
    Please give details of any areas indicated

    Are any of these injuries aggravated by exercise?

    Yes / No

    Are you currently receiving treatment for any structural problem?

    Yes / No

    Please indicate any other health problems you suffer from


    which you have not already mentioned.

    I can confirm that I have answered all questions honestly and that the information given is correct.

    Signature:

    Print name:

    Date:

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