PARQ - Mark Taylor Personal Training, Reading, Berkshire

Telephone 07976 708926

PARQMark2019-04-05T09:17:10+00:00

Physical Activity Readiness Questionnaire

Name *

First

Last

Contact Telephone Number *

Email *

Address

Do you have any heart conditions? *

If yes, please give further details

Do you suffer from any of the following? *

If yes, please give further details

In the last 6 months, have you had any other the following? *

If yes, please give further details

Are you on any medication that could affect an exercise programme? *

If yes, please give further details

Do You Smoke? *

If Yes, how many a day on average do you smoke?

Are you pregnant? *

Is there anything else that i would need to be aware of before you begin an exercise programme? *

If yes, please provide further details

Do you currently participate in any form of regular exercise? *

If Yes, please provide further details

Name

Telphone: 07976 708926

Personal Trainer
Pilates
Golf Fitness
Sports Massage

in Reading, Berkshire and surrounding areas

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