Post a Contest

Par Q - Personal Training Questionnaire (Health Screening)

Status: Closed
Prize: €20
Entries Received: 1
Winner: d3stin

Winner

Contest Brief

GRAPHIC DESIGN ***

Looking to have a Personal Training - Questionnaire designed for my company A&C Fitness. This is a physical activity readiness questionnaire (PAR-Q) to see if clients are ready to exercise safely & have no health conditions that may stop them.

The questions on the PAR-Q aim to uncover heart, circulatory, medication, emotional, and joint problems that could make exercise difficult, or even dangerous for some people. All the questions are designed to help uncover any potential health risks associated with exercise.

I would like to to include the following with enough for the clients to be able to write & fill in...

A&C Fitness - PAR-Q (Physical Activity Readiness Questionnaire)

Name ___________
Age & Date of Birth ___ & _______
Address __________
Sex ________
Phone Number ___________
Email Address ____________
Occupation ____________

Heart Condition? (Tick Box Y OR N)
Chest Pains? (Tick Box Y OR N)
Low/High Blood Pressure? (Tick Box Y OR N)
Dizziness during/after physical exercise? (Tick Box Y OR N)
Pre/Post Natal? (Tick Box Y OR N)
Medication? (Tick Box Y OR N)
Joint/Bone issues? (Tick Box Y OR N)
Currently Injured? (Tick Box Y OR N)
Currently Ill? (Tick Box Y OR N)
Mental Health Issue? (Tick Box Y OR N)

Do you know of any other reason you should not exercise or do physical activity? (Tick Box Y OR N)

If you answered yes to any of the above questions, talk with your doctor BEFORE you begin Training. Tell your doctor of your intention to exercise and which questions you answered ‘yes’ to. If at any stage your health changes, resulting in a ‘yes’ answer to any of the above questions, please seek guidance from a GP

Problem Areas ___________
Goals _____________________
Exercise History _____________
Smoker _____________
Alcohol Intake ___________
Dietary Issues ___________
Hours Sleep Per Night ______

Weight (kg) _____
Height (cm) _____
Activity Levels (TICK BOX - None, Low, Moderate, Active, Very Active)

Do you give permission to A&C Fitness to be able to use your image for promotional & advertisement purposes (Tick Box Y OR N)
Date
Signature

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OldBawnHoop, Ireland.

Top entries from this contest

d3stin Indonesia

1

Public Clarification Board

whitelotus1
- 5 years ago
What is the paper size you want to print-out this form? regular A-4 size? having exact detail about paper size will give me/us more idea to arrange text and images
- 5 years ago
1. Contest Holder
  - 5 years ago
  A4
  - 5 years ago
bhole279
- 5 years ago
can i use two pages?
- 5 years ago
1. Contest Holder
  - 5 years ago
  One please
  - 5 years ago
opmnyc
- 5 years ago
Do you have a logo you wish to embed, or is this purely a text-based form?
- 5 years ago
1. Contest Holder
  - 5 years ago
  The logo should be attached?
  - 5 years ago
2. Contest Holder
  - 5 years ago
  If not i can send to you
  - 5 years ago