Home
|
Contact
|
Sitemap
Primary links
About Us
Philosophy
Accomplishments
Friends
contact
Programs
Training Programs
Masters Swimming
Bike Fitting
Group Training
Core Group
SM 100
Dirt
Personal Training
PF Kids
Coaches
Eric Sorensen
Jason Goyanko
Gail Lohman
Greg Krause
Jenn Brown
Cindy Eckert
Calendar
Resources
Forms
PF Store
Upcoming Workouts
FAAT Masters Swimming
08/08/2008 - 5:30am
FAAT Masters Swimming
08/11/2008 - 5:30am
Sleepy Hollow Bike Intervals
08/12/2008 - 6:00pm
FAAT Masters Swimming
08/13/2008 - 5:30am
Other Upcoming Events
Intermediate Adventure Racing / VentureQuest Preview
09/14/2008 - 1:00pm
All Forms
PAR-Q
Informed Consent
User login
Username:
*
Password:
*
Create new account
Request new password
Training Log
Online Training Log
Username
Password
Navigation
Catalog
Products
Home
PAR-Q
Please answer the following questions to the best of your knowledge.
Name:
*
Your name.
Physician Name:
Name of your physician, if applicable.
Physician Number:
Your physician's phone number
Heart Trouble:
No
Yes
Has your doctor ever informed you that you have heart trouble?
Chest Pain:
No
Yes
Do you frequently experience pains in your heart or chest?
Faint:
No
Yes
Do you often feel faint or have spells of severe dizziness?
Blood Pressure:
No
Yes
Has a doctor ever informed you that your blood pressure is too high?
Joint Pain:
No
Yes
Has your doctor ever informed you of a bone or joint problem may be aggravated or made worse by exercise?
Do you smoke?:
No
Yes
Over 65:
No
Yes
Are you over 65 and not accustomed to vigorous exercise?
Family History of Heart Attack or Stroke?:
No
Yes
Family History of High Blood Pressure?:
No
Yes
Family History of Diabetes?:
No
Yes
Other Reason:
No
Yes
Is there a good reason, not mentioned here, why you should not follow a vigorous conditioning program even if you wanted to?
Explanation:
If you answered, Yes, to any of these questions, please explain. You also may be required to complete a medical clearance form.
Other Medical History:
Please discuss any medical conditions that would be pertinent to designing, implementing and evaluating your training program.
Medication:
Please list any medications you are taking or have recently taken. Include dosage and purpose for taking it.
Injuries:
Elbow:
Indicate any injures. Please include cause of injury, treatment and current status.
Back:
Indicate any injures. Please include cause of injury, treatment and current status.
Abdominal:
Indicate any injures. Please include cause of injury, treatment and current status.
Wrist:
Indicate any injures. Please include cause of injury, treatment and current status.
Ankle:
Indicate any injures. Please include cause of injury, treatment and current status.
Shoulder:
Indicate any injures. Please include cause of injury, treatment and current status.
Hand:
Indicate any injures. Please include cause of injury, treatment and current status.
Hip:
Indicate any injures. Please include cause of injury, treatment and current status.
Knee:
Indicate any injures. Please include cause of injury, treatment and current status.
Neck:
Feet:
Indicate any injures. Please include cause of injury, treatment and current status.
