Request a Personal Trainer

personal trainer

1. Physical Activity Readiness Questionnaire (PAR-Q)

For most people, physical activity should not pose any 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 is your best guide in answering these few questions. Please read them carefully and check yes or no for the question if it applies to you.


Has your doctor ever said you have a heart condition?

Yes
No

Do you frequently have pains in your heart and/or chest?

Yes
No

Do you often feel faint or have spells of severe dizziness?

Yes
No

Has a doctor ever said your blood pressure was too high?

Yes
No

Has a doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise, or might be made worse with exercise?

Yes
No

Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?

Yes
No

Are you over age 65 and not accustomed to vigorous exercise?

Yes
No

Are you currently prescribed or taking over the counter medications that will affect your heart rate and/or blood pressure?

Yes
No

If you answered NO to all questions

If you answered PAR-Q accurately, you have reasonable assurance of your present suitability for an exercise program.


If you answered YES to one or more questions

Talk to your doctor by phone or in person BEFORE you start becoming more physically active or BEFORE you have a fitness evaluation. Tell your doctor about the PAR-Q and which questions you answered YES.

Delay becoming more active.

If you are not feeling well because of a temporary illness such as a cold or a fever, wait until you feel better;
If you are or may be pregnant, talk to your doctor before you start any physical activity.

Please note: If your health changes in a way that would cause you to answer YES to any of the above questions, inform your fitness or health professional. Ask whether you should change your physical activity plan.


Participant Information Form

Fields in red are required.

Personal Information

Name

Classification

Age

Contact Information

Home Phone

Work Phone

Cell Phone

Email

Client Availability

When are you available to meet with your trainer? Please list as many times as possible and be specific: (Does not require commitment)

Name of Personal Trainer Preferred

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Additional Information/Question


State law requires that you be informed of the following:

  • With few exceptions, you are entitled on request to be informed about the information the University collects about you by use of this form.
  • Under sections 55.021 and 552.023 of the Government Code, you are entitled to receive and to review the information.
  • Under sections 559.004 of the Government Code, you are entitled to have the University correct information about you that is incorrect.