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***Evolve PTUK Par-Q Form***

PLEASE NOTE!

It Is Advised You Speak To Your Local Doctor Before Taking Part In Any Physical Exercise.

All Clients Must Be Over 18 Years.

Please Fill In The Correct Details Below.

Your Name (required)

Your Surname (required)

Your Email (required)

Age (required)

Date Of Birth (required)

Gender (required)

Hight (required)

Weight (required)

Any Injuries? (required)

Any Illnesses? (required)

Are You Pregnant? What Trimester Are You In? (required)

Have You given birth in the last 8 weeks? (required)

Have You Ever Had Chest Pains Whilst Exercising? (required)

Do you have chest pains when you are not Exercising? (required)

Are you using any medication? (required)

Have you ever been told you have high blood pressure? (required)

If you have answered Yes to 1 or more to any of the questions above you must see a doctor before you begin training.

What are your goals? (required)

Why do you want to achieve these goals? (required)

Possible commitment problems (i.e. work/family)? (required)

How many days per week can you commit to training? (required)

Do you have at least an hour per session? (required)

Exercise Like/dislikes (i.e. press ups/running) (required)

Do you have any Food Allergies (For Tailored Clients)? (required)

Please Describe your fitness level (Choose one) (required)

Your Message (required)

By submitting this form I confirm that I am the client and at the time of the declaration have been advised by my family Doctor that I am in good health to begin training, I also take full responsibility that I will inform my family Doctor and Evolution Personal Fitness of any change in my well being I can also confirm that all the above information I have provided is correct. I confirm I am the card holder and agree to all Evolution Personal Fitness Terms and conditions.