Pre-Exercise Questionnaire

2. On a scale of 0 - 10, how important is it to you that you achieve this goal? And, is there a goal you have that is level 10 of importance? *

7. Do you foresee any obstacles that could prevent you from reaching this goal? If so, what are they? Are these some of the same obstacles you faced in the past? *

8. On a scale of 0 - 10, what is your confidence level in your ability to achieve this goal alone? If its less than a 10, what would it take to move it closer to a level 10? *

12. If you are currently working out, are you seeing the results you were looking for from your current program? If not, what do you feel needs to change? *

13. Does your job require any of the following? *

Prolonged sitting or driving Moderate movement Heavy lifting Repition bending, lifting, or twisting

15. In what ways do your current habits play in a positive role in helping you achieve your goal? In what ways do they play in a negative role? *

This PAR-Q is designed to help you help yourself. Many health benefits are associated with regular exercise, and the completion of the 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 if your best guide in answering these few questions. Please read them carefully and check the correct answer below the question.

Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising with medical supervision? *

Yes No

If you have answered YES to one or more of the above questions, please answer the following:

If you answered no to the question above, will you consult with your physician prior to increasing your physical activity and or performing a fitness assessment? *

Yes No

If you would like to submit a BEFORE photo as part of your folder, please do so by clicking the UPLOAD FILE hyperlink below. It is very important to have a BEFORE and a AFTER photo on hand when displaying the physical changes along the way.