PAR Form | Loubie Core Pilates

Physical Activity Readiness Form

Please fill out this health declaration form before booking your first class. Unfortunately without submitting you will not be able to join class however you booking will still be charged.

First Name

Contact number

Last Name

Questionnaire:

Has your doctor ever said that you have a heart condition and that you should
only do physical activity recommended by a doctor?
Do you have either high or low blood pressure? If yes, which type?
Have you ever felt pain in your chest when you do physical exercise?
In the past month, have you had chest pain when you were not doing physical activity?
Do you often feel faint, lose your balance because of dizziness or have you ever lost consciousnes
Have you ever suffered from unusual shortness of breath at rest or with mild exertion?
Has the doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or that may be made worse by exercise?
Are you, or is there any possibility that you might be pregnant, or have you been
pregnant in the last 6 months?
Are you currently on any prescribed medicines that may affect your ability to exercise?
Do you know of any other reason that may affect your ability to participate in physical activity?

No to all

Yes to some

If yes, please elaborate. If no, please enter n/a

Select a date

I confirm that the information given in this form is true.

Thanks! see you in class soon!