Indie Fitness Par-Q

Full Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Gender

Date of Birth

MonthDayYear

Age

years

What do you do for a living?

Whats the activity level at your job?

Do you follow a regular working schedule, do you work days, afternoon or nights?

Please list the physical activities that you participate in outside of the gym and outside of work.:

If you have any diagnosed health problems list the condition(s).

If you are on any medications, please list them.

What additional therapies are being undertaken for the given health problem(s)?

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury?

Are you experiencing any stresses or motivational problems?

Has anyone of your immediate family developed heart disease before the age of 60?

Do any diseases run in your family?

Do you suffer from diabetes, asthma, high or low blood pressure?

if yes please list:

Are you a current cigarette smoker?

Your current diet could be best characterized as:

Please rate your readiness for change.

What following goals does best fit in with your goals?

What is your goal with your training?

Why?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

How often are you willing to train a week to reach your goal?

Please rate your motivational level to do what it takes for reach your goal.

Are you currently excersising regulary (at least 3x per week)?

Have you trained with a personal trainer before?

If yes what kind of training did you do:

At what times during the day would you prefer to train?

1.) Dance and Fitness classes can involve risk of personal injury. While we take all reasonable care in the conduct of the classes, we accept no responsibility for injury or loss during classes, or while participants are at or near the class venue.

I participate in the activity at my own risk and responsibility. I agree that I may be in a photo or video taken during indie Fitness classes and I give my permission for them to publish either

2.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

3.) COVID 19 POLICY

All clients must scan in via the SAFEWa app or provide written detains on the form provided.

All clients must use the hand sanitizer provided

Classes may be cancelled due to Government Lockdown protocols without penalty to Indie Fitness.

4.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

Before signing this document I have read and understood it and no that it affects my legal rights.

I AGREE TO THE ABOVE TERMS & CONDITIONS!

Part 1. Basic information

Indie Fitness Consultation Questionnaire

Part 2. Lifestyle Information

Part 3. Medical and health information

Part 4. Goals

Please Read The Following Terms and Conditions.