Alexandra Murray Massage

Personal Training PAR-Q+

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Personal Details

Tell us a little about yourself.

First Name *

Surname *

Address *

Phone *

Email *

Date of Birth * You can type your date of birth (dd/mm/yyyy) or choose it from the calendar.

GP name & surgery

Emergency contact name

Emergency contact phone

Relationship to you

Physical Activity Readiness Questionnaire (PAR-Q+)

Has a doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?

Yes No

Do you feel pain in your chest when you do physical activity?

Yes No

In the past month, have you had chest pain when you were not doing physical activity?

Yes No

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes No

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes No

Is your doctor currently prescribing drugs for your blood pressure or heart condition?

Yes No

Do you know of any other reason why you should not do physical activity?

Yes No

Current Fitness & Goals

How often do you currently exercise?

What are your fitness goals?

Current or previous injuries

Measurements (optional)

Weight (kg)

Height (cm)

Body fat % (optional)

Waiver & Consent

I understand that exercise involves risk and I participate at my own risk. I confirm the information provided is accurate. *

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Data Protection (UK GDPR)

I consent to my personal data being processed for the purposes of my treatment and care records, in accordance with UK GDPR. *

I hereby declare that the details are true and correct to the best of my knowledge and I undertake to inform you of any changes immediately. I have read and acknowledged the Privacy/GDPR policy. Thank you kindly for visiting us today and completing this form. Hope to see you again soon.

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Client Signature *

Please sign below.

Please provide your signature

Date *

Age Restriction

We can only offer treatments to people aged 16 and over.

Additional Information

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