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LAWRENCE PRICE
Fitness
Hosting Events/Workouts
Social Media/Creative Services
Model & Presenter
In the Media
Physical Activity Readiness Questionnaire (PAR Q)
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Indicates required field
Name
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First
Last
Sex
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Male
Female
Phone Number
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Email
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Have you ever been diagnosed with a heart condition?
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Yes
No
Has a doctor ever said you should only participate in medically supervised physical activity?
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Yes
No
Is there a history of heart and coronary artery disease in your family?
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Yes
No
If so, who?
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Do you suffer with palpitation?
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Yes
No
Do you ever suffer from chest pain?
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No
Yes, during exercise
Yes, during physical activity
Yes, at rest
Is your blood pressure known to be high?
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Yes
No
If yes, please list the medication you take
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Do you experience loss of balance due to dizziness?Choose One
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Yes
No
Do you lose consciousness?
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Yes
No
Do you experience shortness of breath?
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Yes
No
Do you suffer from any of the following:
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Diabetes
Asthma
Epilepsy
Any other chronic diseases
If yes, list the medication you take
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If you have had any injuries (ankle, knee, hip, back, shoulders, etc.) or suffer from muscular pain or cramps please give details below:
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If you have any infections or infectious diseases or suffered a serious illness recently please give details below:
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Is your cholesterol level known to be high?
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Yes
No
I don't know
Please select if any of the following options are true:
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I am pregnant
I have given birth in the last 6 months
Please give details of any medication you take not mentioned above
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Give details of any physical reason not mentioned here why you should not follow a certain activity programme even if you wanted to?
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Statement: I confirm that the answers to the above questions to the best of my knowledge are correct. I will also immediately inform Lawrence Price should any of the foregoing change. I agree that participating in training via the suggestions of Lawrence Price will be my own choice and I do not hold Lawrence Price responsible for any injuries that I may incur. It is my responsibility alone to practice correct form and select a suitable load whilst exercising independently.
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I understand and agree
Submit
Fitness
Hosting Events/Workouts
Social Media/Creative Services
Model & Presenter
In the Media