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About This Form


PAR-Q is designed to help you help yourself. Many health benefits are associated with regular exercise, and the completion of a PAR-Q is a sensible first step to take if you are planning on increasing the amount of physical activity in your life. For most people physical activity should not pose a problem or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Common sense is your best guide in answering these questions.

The TriNeet Fitness Promise To You

When you book me as your Personal Trainer you will receive: A complete workout plan (if required) prepared personally by me. Your training schedule will be based on:

  • Your chosen fitness goals

  • Your chosen training methods

  • Your personal fitness and health level

  • Safe personal training plan based on safe and correct technique(s)
  • Practical teaching experience, over 30 years as an athlete and my qualifications have taught methat this is the only effective way to avoid injuries and achieve your full potential

  • A weekly "feedback and motivate" by phone or email including updates to your exerciseschedule as you progress and nutrition tips

  • 100% Respect, patience and support.

(*)
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About You

First Name(*)
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Last Name(*)
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Address Line 1(*)
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Address Line 2
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Address Line 3
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Post Code(*)
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Home Telephone(*)
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Mobile Telephone
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Work Telephone
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Email(*)
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Occupation
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Date of Birth(*)
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Height(*)
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Weight(*)
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Emergency Contact Details

Name(*)
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Relationship
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Address Line 1
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Address Line 2
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Post Code
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Home Telephone(*)
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Work Telephone
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Mobile Number
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Your Doctor's Details

Name(*)
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Surgery Address(*)
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Post Code(*)
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Telephone Number(*)
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About Your Health and Fitness Goals

What health and fitness goals would you like to achieve in the next 3 months? i.e. lose 7lbs, start a running programme etc(*)
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What health and fitness goals would you like to achieve over the next 12 months?(*)
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Name 3 things you will do in order to improve your health and fitness

1(*)
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2(*)
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3(*)
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Would you like TriNeet Fitness to record your body measurements each month? This will include measuring parts of your body and taking a body fat %(*)
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Which areas of your body do you want to target? State all that apply(*)
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About Your Exercise Habits

What are your main reasons for starting a fitness program?(*)

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Other (please give details)
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Have you ever done any structured exercise?(*)
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(If answered Yes to the above question) What activities did you do? Please also state how hard you worked and for how long
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How long did you do this for?
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How many times per week did you complete this type of activity?
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Did you get the results you've hoped for?
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If you answered Yes to the above question, why did you stop?
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How would you describe your current fitness condition? Please give details of your current exercise programmes, if applicable(*)
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What types of exercise do you enjoy the most?(*)
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What types of exercise do you NOT enjoy?(*)
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What would you identify as the main barriers preventing you from exercising in the future? Check all that apply(*)

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Other (Please give details)
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What training environments do you enjoy?(*)

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Other (please give details)
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What are your preferred training methods? Check all that apply(*)

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Other (please give details)
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Do you prefer your workout to

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Your Nutritional Needs

On a scale of 1-5 how would you assess the quality of your diet?(*)
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Do you follow a particular diet? Please check all that apply(*)
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Other (please give details)
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Would you like any advice or support to help you make any changes to the quality of your diet?(*)
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If you answered Yes to the question above, please state below your 3 goals for doing this

If you answered Yes to the question above, please state below your 3 goals for doing this

Goal 1(*)
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Goal 2(*)
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Goal 3(*)
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Have you had your diet analysed before?(*)
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If you answered Yes above, please give more details
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What would you say are your nutritional weaknesses?(*)

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Other (Please give details)
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Please list any mineral supplements you currently take
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Do you:(*)

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About Your Lifestyle

How many units of alcohol do you drink in a typical week? One unit of alcohol equals: (1/2 pint of a standard beer/lager, 1 small glass of wine, 1 pub measure of a spirit)

No. of Units(*)
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Do you smoke?(*)

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If you answered Yes, please indicate the number smoked per day

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Would you like help to stop smoking?(*)

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How many hours do you regularly sleep?(*)
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Describe your job

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About your Structural Health

Do you have any of the following conditions? Please check all that apply

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If you answered Yes to any of the conditions above, please give further details here
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Are these or any other injuries aggravated by exercise? If Yes, please give further details here
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Are you currently receiving physical therapy?(*)
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If Yes please give further details here
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About your Medical History

Based on your answers in this section we may ask your permission to seek your GP's advice before commencement of any exercise programme.

Is there a family history of any of the following medical conditions? Please check all that apply(*)

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Other (Please give details)
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Have you had major surgery in the last 10 years(*)
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If Yes please give details
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Please tick any of the following for which you have been diagnosed or treated by a doctor or a health professional

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Other (Please give details)
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Please state if you have taken any of the following medications in the last 6 months(*)

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Please state other relevant medications not listed
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Tick the box if you have ever experienced any of the following symptoms. Do you...(*)

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Please list any health problems you suffer from, not already mentioned
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Are you currently pregnant or have you given birth in the last 12 months?(*)
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Declaration

I confirm that to the best of my knowledge the information given within this document is correct and I understand that it will be treated with strictest confidence by TriNeet Fitness (and by those acting for and on behalf of TriNeet Fitness) for services that I may wish to engage in now and in the future.

Name(*)
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Date(*)

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By submitting this form, I agree to...
  • Inform TriNeet Fitness of any aches, pains or illnesses have I that I have had since the previous session
  • Let TriNeet Fitness know if I need to cancel a session by calling at least 24 hours before the scheduled time
During all training sessions I agree to...
  • Wear loose comfortable clothing
  • Wear trainers/sensible footwear suitable for exercising
  • Stay hydrated by having a bottle of water/energy drink close by
  • Let TriNeet Fitness know periodically how I feel about the training session (too hard, too easy, just right")
  • Ask for a water break if I need it
After the training session I will...
  • Take part in stretching and cool down exercises
  • Feedback any thoughts which can be taken into consideration for the following session

Click this button to submit your finished form.