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Frwdstrong Physical Activity Readiness-Questionnaire (FPAR-Q)

DOB
Month
Day
Year
Gender
Male
Female
Whats the activity level at your job?
None (seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
How often do you travel?
Rarely
A few times a year
A few times a month
Weekly
Are you experiencing any stresses or motivational problems?
Yes
No
Has anyone of your immediate family developed heart disease before the age of 60?
Yes
No
Do any diseases run in your family?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
Are you currently a cigarette smoker?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
No special diet
Vegetarian/Vegan
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
What following goals best fit in with your goals?
Improved health
Fat loss
Improved endurance
Increased strength
Increased muscle mass
Please rate your motivational level to do what it takes for reaching your goal.
1
2
3
4
5
6
7
8
9
10
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Have you trained with a personal trainer before?
Yes
No
What times of the day do you prefer to train?
Morning
Afternoon
Mid-day
Evening
Other
How often do you want to do Personal Training a week?

Please Read The Following Terms and Conditions

1.) 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.

 

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

 

3.) 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.


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