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Methodology X
About
Contact
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Work With Me
All Services
Private Coaching
Programmes
Retreats
Methodology X
Programmes
StEP 1: complete the following PARQ & Informed consent Form
Name
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Email
*
Contact Number
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cycle Information
*
Do you currently
Have a natural cycle
Take an oral contraception
Have an IUD
Post Menopause
Other
Cycle Length
*
Do you know how long a typical cycle length is? If Yes how long?
Next of Kin
*
Next of Kin Contact Number
*
Regular activity is fun and healthy and increasingly more people are starting to become more active from working out at home. However, in some cases you may need to check with your doctor first. Many benefits are associated with regular exercise, and completion of the PAR-Q form below is a sensible first step to take if you are planning to increase the amount of physical activity in your life. For most people, physical activity should not pose a problem or hazard. The PAR-Q has been designed to identify the small number of people for whom physical activity might be inappropriate or for those who should seek medical advice concerning the type of activity most suitable for them. Common sense is your best guide for answering these questions. Please answer them honestly.
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 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
Do you have a bone or joint problem (e.g. back, knee or hip) that could be made worse by a change in physical activity?
*
Yes
No
Is your doctor currently prescribing drugs (e.g. water pills) for your blood pressure or heart condition?
*
Yes
No
Do you know of any other reason why you should not do physical activity?
*
Yes
No
If you answered YES to any of the above questions, then you are required to talk to your doctor by phone or in person BEFORE participating in the exercise programme. If you have answered NO to all of the above questions and you have reasonable assurance of your suitability for: - Becoming more physically active, begin slowly and build up gradually - Take part in online workouts - A progressive and varied approach to training, including but not limiting to conditioning, strength, cardiovascular, mobility and stability You are advised to DELAY entry into the programme if you feel unwell or have a temporary illness. You must inform your fitness professional/personal trainer of any changes to your health status, whilst engaged in your training programme.
“I have read, understood and competed this questionnaire. Any questions I had were answered to my full satisfaction.”
Members Name
*
Date
*
MM
DD
YYYY
Informed Consent for Exercise
Programme objectives and procedures I understand that the purpose of the exercise programme is to provide safe and effective exercise to improve my health and fitness. Exercise may include: Resistance training activities – using resistance bands, free weights, gliders, or circuit high intensity training to improve muscular strength or endurance. Core, mobility & flexibility – exercises to improve core stability, posture and movement around the main joints and range of motion. Cardiovascular activities – skipping, running and other activities to improve cardiovascular ability. Potential benefits I understand that a programme of regular exercise has been shown to be beneficial. Some of these benefits include: A decrease in risk of heart disease A decrease in body fat Improved blood pressure Improvement in psychological function Improvement in aerobic fitness Potential risks The exercise programme is designed to place a gradually increasing workload on the cardiovascular and muscular systems and thereby improve their function. The reaction of the cardiovascular and muscular system to such exercise cannot always be predicted with complete accuracy. There is risk of certain changes that might occur during or following exercise. These changes could relate to blood pressure or heart rate. Safe Environment I understand that I am responsible to ensure the environment I choose to exercise in is safe, free from hazards that may cause me to slip, has adequate ventilation and enough space to undertake the workout. I am happy with the explanation of the training programme which has been explained to me and my questions regarding the programme have been answered to my satisfaction. I understand that I am free to withdraw at any time. The information obtained will be treated as private and confidential.
I hereby sign the below to confirm that I provide full consent to participate in the proposed activities and that by doing so I accept the risks identified. I also understand that I may withdraw at any time.
Members Name
*
Date
*
MM
DD
YYYY
Thank you!
