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Lifestyle Form
Par Q

Name

Health and Lifestyle Questionnaire

Lifestyle

Have you trained before, and what level would you class yourself as?
Select all the activities you interested in...

Nutrition and more

Do you smoke?
Do you drink alcohol?

Please give a rough idea of how many cups of the following you consume per day.

Please give a brief description of yesterday's food diary snap shot...

Goals

Please list THREE goals, in order of importance...

What is the biggest challenge you must overcome to attain your goal?
How did you first find out bout my services?

Physical Activity Readiness Questionnaire (PAR-Q) 

- If you make any changes here, please inform your coach

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had a chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose conciousness?
Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart?
Do you know of any other reason why you should not do physical activity?

YES TO ONE OR MORE QUESTIONS:

You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

NO TO ALL QUESTIONS:

It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A physical performance assessment can help determine your ability levels. 

Original Date of submission:

Thursday, 8 February 2024 at 21:31:54 UTC

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