Par Q – Readiness – SGB Fitbodies

Name(Required)

First Last

Phone(Required)

Email(Required)

Date(Required)

1. Has your doctor ever told you that you have a heart condition and that you should only do physical activity recommended by a doctor?(Required)

YES

2. Has your doctor ever told you that you have a heart condition and that you should only do physical activity recommended by a doctor?(Required)

YES

3. Do you feel pain in your chest when you do physical activity?(Required)

YES

4. Do you lose your balance because of dizziness or do you ever lose consciousness?(Required)

YES

5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?(Required)

YES

If you answered yes to the above please list and explain specifically below.....

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

YES

If you answered yes to the above please list and explain specifically below.....

7. Do you know of any other reason why you should not do physical activity?(Required)

YES

If you answered yes to the above please list and explain specifically below.....

8. Are you pregnant or Post Natal?(Required)

YES

9. On a scale of 1-10 where would you rate your stress level? 1= No stress - 10= Extreme Stress(Required)

Please enter a number from 1 to 10.

10. Are you currently a smoker?(Required)

Other

11. On average how many hours of sleep do you get per night?(Required)

12. How active have you been in the last 6months?(Required)

13. What would you rate your current fitness level ?(Required)

14. What is your top reason for starting a fitness program?(Required)

15. Is there any other relevant information I should be made aware of as your trainer.(Required)

I verify that I have disclosed all pertinent information to SGB Fitbodies. I agree and understand that it is my responsibility to inform SGB Fitbodies if anything changes. I am responsible for choosing the correct levels, modifications and intensities for me. I do not hold SGB Fitbodies responsible for my well being. I understand it is my choice to take reccomendations or suggestions upon my discretion and it is not a perscription. I understand it is up to me to consult a Dr. if an issue or injury presents itself.