Let’s work together!Physical Activity Readiness Questionnaire (PARQ)These questions help me form a program and get to know you. Name * First Name Last Name Email * Phone * (###) ### #### What services are you interested in? * In Person - Personal Training Virtual - Personal Training Small Group Training (2 people) Small Group Training (3+ people) What do you want to accomplish with your training? (i.e. your goals or intention - gain muscle, gain strength, mobility, mental well-being, etc..) * What (if any) are your perceived limitations or vulnerabilities associated with adopting new behaviors? * What are you willing to give up? (three non-competing goals) * How much time do you have each week? (things to consider: current obligations, stress, finances, etc) * Has your doctor ever said that you have a heart condition or high blood pressure? * Yes No Do you feel pain in your chest at rest, during your daily activities of living, or when you do physical activity? * Yes No Do you lose balance because of dizziness or have you lost consciousness in the last 12 months? * Yes No Have you ever been diagnosed with another chronic medical condition (other than high blood pressure or heart disease)? (Please list conditions below if any) * Are you currently taking prescribed medications? * Do you currently have (or have had within the last 12 months) a bone, joint, or soft tissue (muscle, ligament, tendon) problem that could become worse with more physical activity? * Rate these in the order of importance for YOU: (1) Muscle Gain - (2) Strength Gain - (3) Weight Loss - (4) mobility improvement - (5) postural improvement * Thank you! I will reach out to you within 24 hours!With gratitude,Alex Jeffers