Coaching Consultation & Health Questionnaire (PARQ)MEDICAL & PHYSICAL Name * First Name Last Name Height in CM * Weight in kgs * Waist circumference in CM * Has your doctor ever said that 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 any 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 Is your doctor currently prescribing drugs for blood pressure or a heart condition? * Yes No Do you know of any other reason why you should not do physical activity? * Yes No Do you currently take any medication? If yes, what? * Do you currently take any health supplements? If yes, what? * What else do you think I need to know? * Females only Do you get regular periods? Yes No Have you previously lost your period? If yes, please give as much detail on the circumstances that lead there as possible. Do you use hormonal contraceptives? Yes No Is there anything else you would like to add? If so, please do so here. Thank you!
