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Physical Activity Readiness Questionnaire (PAR-Q) & Bespoke Program Template

Information & Details

What is the date and time?
Day
Month
Year
Time
HoursMinutes

Physical Activity Readiness Questionnaire (PAR-Q)

Has your General Practitioner (GP) or a licensed medical professional ever stated that your blood pressure were too high or too low?
Yes
No
Has your General Practitioner (GP) or a licensed medical professional ever stated that your cholestrol levels were too high or too low?
Yes
No
Do you have trouble respirating (breathing)?
Yes
No
Do you have any chronic diseases?
Yes
No
Has dizziness ever caused your balance to be unstable?
Yes
No
Have you ever been unconscious?
Yes
No
Do you vape/smoke?
Yes
No
Do you consume any alcoholic beverages?
Yes
No
Do you have any orthopaedic injuries?
Yes
No
Do you have any stiff or swollen bones/joints?
Yes
No
Do you have any tension, soreness or pain?
Yes
No
Are you consuming any prescribed medication or dietary supplementation?
Yes
No
Have you ever had surgery?
Yes
No
Are you pregnant or post-partum?
Yes
No
Do you have any dietary requirements?
Yes
No
Do you have any other medical conditions we should be aware of?
Yes
No

Bespoke Program Template

Which days are you training sessions at the gym?
What is the number of days you train at the gym per week?
What time frames are your training sessions?
How long are your training sessions?
15 - 30 Minutes
30 - 45 Minutes
45 Minutes - 1 Hour
1 Hour - 1.15 Hours
1 Hour - 1.5 Hours
1.5 Hours - 2 Hours+
None
Do you have a current workout split?
Yes
No
Do you have a preferred workout split?
Yes
No

Workout Split: a workout split is the way a training program is divided into separate sessions, usually by muscle groups or movement types, across different days of the week.

Which muscle groups do you want to priortise?
Which pieces of equipment do you prefer to use?
Do you prefer compound and/or isolation exercises?
Compound Exercises
Isolation Exercises
Both
Other
None

Compound Exercise: a movement that works multiple muscles and joints at once, making it efficient for strength and fitness. Examples include squats, deadlifts, bench press, pull-ups, overhead press, rows, and lunges. Isolation Exercises: a movement that targets a single muscle group and joint, making it useful for focused strength or rehab. Examples include bicep curls, tricep pushdowns, leg extensions, hamstring curls, lateral raises, and calf raises.

What is your preferred rep range?
1 - 5 Reps (Strength & Conditioning)
5 - 8 Reps (Functional Hypertrophy)
8 - 12 Reps (Traditional Hypertrophy)
12 - 20+ Reps (Endurance)
What is your preferred level of intensity?
Low Intensity (3+ Reps In Reserve)
Moderate Intensity (2 - 3 Reps In Reserve)
High Intensity (1 - 2 Reps In Reserve)
Do you have any preferences or suggestions for your bespoke health, fitness, and wellness program?
Yes
No
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