WOW PILATES

Name: WOW PILATES
Address: 39 Mortimer Crescent, Kings Park, St Albans, AL3 4GB, GB
Telephone: 07960 031313
Price range: £

E: info@wowpilates.net

M: 07960 031313

W: www.wowpilates.net

Physical Activity Readiness - Questionnaire (PAR-Q)

Are you completing this form for yourself or on behalf of someone else?

Single choice

Yourself

Someone else

Client - Full name

Client - Email

Client - Mobile Phone Number

Client - Residential Address

Client - Birthday

Day

Month

Year

Emergency Contact - Full Name

Emergency Contact - Phone Number

Emergency Contact - Relationship to Client

If the client is under 18 years, who is the parent or legal guardian

Starting a Pilates Programme

If you are between the ages of 15 and 69, this PAR-Q form will tell you if you need to check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being physically active, check with your doctor.

Please read each of the questions below answering honestly:

Has your doctor ever said you have a heart condition and you should only do physical activity recommended by your doctor?

Single choice

Option 1

Option 2

Do you feel pain in your chest when you do physical activity?

Single choice

Option 1

Option 2

In the past month, have you had chest pain when you were NOT doing physical activity?

Single choice

Option 1

Option 2

Do you lose balance because of dizziness or do you ever lose consciousness?

Single choice

Option 1

Option 2

Do you have a bone or joint problem (for example back, knee or hip)?

Single choice

Option 1

Option 2

Is your doctor currently prescribing medication for your blood pressure or heart condition?

Single choice

Option 1

Option 2

Do you know of any other reason why you should not take part in physical activity?

Single choice

Option 1

Option 2

If you have answered YES to any of the above, please add comments here:

If you have any additional information you may upload files here, using the "Upload File" button.

File upload

Supported file formats: pdf. jpg, png. csv. doc.???

Date You Completed This Form

Day

Month

Year

Please check this box to indicate you have read, understood and agree to WOW PILATES "Terms and Conditions". By attending session at WOW PILATES you will also be giving you consent

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Please check this box to indicate you have read, understood and agree to WOW PILATES "Recording Policy"

This form and all information within is, Private and Confidential, for use by WOW PILATES only.

Version 1.0 | October 2025