Questionnaire

What are your goals?

Physical Activity Readiness Questionnaire (PAR-Q)

Please provide YES or NO to the following questions.

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

YesNo

Do you feel pain in your chest when you perform physical activity?

YesNo

In the past month, have you had chest pain when you were not performing any physical activity?

YesNo

Do you lose your balance because of dizziness or do you ever lose consciousness?

YesNo

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

YesNo

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?

YesNo

Do you know of any other reason why you should not engage in physical activity?

YesNo

If you have answered YES to one or more of the above questions, consult your physician before engaging in physical activity. Tell you physician which questions you answered YES to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.

General and Medical History

Occupational

What is your current occupation?

Does your occupation require extended periods of sitting?

Does your occupation require repetitive movements? (If YES, please explain.)

Does your occupation require you to wear shoes with a heel (e.g., dress shoes)?

Does your occupation cause you mental stress?

Recreational

Do you partake in any recreational physical activities (golf, skiing, etc.)? (If YES, please explain.)

Do you have any additional hobbies (reading, video games, etc.)? (If YES, please explain.)

Medical

Have you ever had any injuries or chronic pain? (If YES, please explain.)

Have you ever had any surgeries? (If YES, please explain.)

Has a medical doctor ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes? (If YES, please explain.)

Are you currently taking any medication? (If YES, please explain.)

What is your current exercise plan? What time of the day do you train? How often do you train?

Do you have any dietary restrictions? Do you have any food allergies? List the foods you will not eat. Please tell me the foods you normally eat in a day.

Do you drink alcoholic beverages? (If so, how much per week)

Are you taking any supplements? If so, what are they?

Additional Information

By submitting the questionnaire, I have read, understood and agreed to the Terms of Service.