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Home
Blog
Services
- Xtreme Fat Loss Programme
About
- The Resilience Coaching Principles
Contact Me

Physical Activity Readiness Questionnaire – PARQ

Before you start training with me, you must complete this PAR-Q. The information contained within this form will help determine if it is safe for you to do so.
If there is ever any doubt regarding your fitness to train you should seek advice from your doctor.
If you or anyone in your household or immediate workplace are showing any of the symptoms of COVID-19 shown below or test positive for COVID-19, you should not attend any in-person sessions and notify me as soon as possible.
- A new continuous cough
- Fever/high temperature (37.8C or greater)
- Loss of, or change in, sense of smell or taste (anosmia)
A new continuous cough is where you:
- have a new cough that’s lasted for an hour
- have had 3 or more episodes of coughing in 24 hours
- are coughing more than usual
A high temperature is feeling hot to the touch on your chest or back (you don’t need to measure your temperature). You may feel warm, cold or shivery.
If you have any more serious symptoms, including pneumonia or difficulty breathing, you should consider contacting the hospital.
All information you record on this form will be treated with the utmost confidentiality, it will be stored in a secure place and made available to you at any time. You are not required to provide information on health conditions, however by signing this form you are declaring that there is no health-related reason why you should not, or cannot, exercise.
Contact details
Title*
Preferred title:
Name*
First Last
Address*
Street Address City ZIP / Postal Code Country
Date of Birth*
Date Format: DD slash MM slash YYYY
Contact Telephone Number*
Email*
Emergency Contact Name*
Emergency Contact Telephone Number*
Additional comments about contact details (if applicable):
Health assessment
Have you ever had any medical condition, surgical operation or injury?*
- Yes
- No
Please provide details*
Do you suffer chest pains upon exertion and/or at rest?*
- Yes
- No
Please provide details*
Do you regularly take medication (either prescription or non-prescription)?*
- Yes
- No
Please provide its name, dose and for what it is prescribed*
Do you suffer from regular headaches, dizziness, fainting or fits?*
- Yes
- No
Please provide details*
Is there a possibility that you have been pregnant, or have you given birth in the last 6 months? (Also note any miscarriage, pregnancy or fertility problems)?*
- Yes
- No
Please provide details*
Do you have high blood pressure?*
- Yes
- No
Are you over the age of 65 and unaccustomed to vigorous exercise?*
- Yes
- No
Do you have any bone or joint problems that could be affected by exercise?*
- Yes
- No
Please provide details*
Do you have any food allergies, intolerances or sensitivities?*
- Yes
- No
Please provide details*
Is your GP aware of your intention to modify your exercise and nutrition behaviours?*
- Yes
- No
Is there any further information you feel I should be aware of?*
- Yes
- No
Please provide details*
Changes in health
If you proceed with an exercise and nutrition programme and, during that period, your health changes, please consult your doctor and inform me as soon as possible, as you may need to change or even suspend your physical activity.
Exercise history
Have you exercised regularly for more than three months in the last two years?*
- Yes
- No
How would you describe your current level of fitness, overall health and wellbeing?
By submitting this form, I confirm and agree to the following:
- The details I have provided are correct and that I will consult my doctor immediately if anything changes that may affect my ability to exercise or related to my emergency contact details.
- If I feel light-headed, faint, chest pain, leg cramps, fatigue, discomfort, pain or nausea whilst exercising, then I will immediately stop.
- To only use equipment which is suitable to my abilities and competencies and will seek advice if I do not know how to correctly use or operate it.
- If I or someone in my household is showing signs show signs of COVID-19, I will notify my coach immediately.
- Are you human? If so, please enter the details from the image below.

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About The Company

Resilience Fitness was founded to help people achieve optimal well-being through individualized exercise and nutrition. The service is bespoke and personal, with no two people coached the same way. My goal is to build a better future for my clients and the people most important to them.

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Contact Me

If you're interested in working with me, want more information on my services or simply have a question that you think I might be able to answer, then get in touch using the form below. I'd love to hear from you.
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Email*
Message
Are you a real person? Please enter the details shown below.

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