This form is a Physical Activity Readiness Questionnaire. This is a short survey that helps determine if you are physically healthy to join online fitness coaching with - Marc Hector coaching.

Please state your full name *

Please write your date of birth *

What is your current and most used email address? *

What is your mobile phone number? *

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

Yes

No

Do you tend to fall over as a result of dizziness? *

Yes

No

Do you have a bone or joint problem that could be or has been aggravated by exercise? *

Yes

No

Has your doctor ever recommended medication for your blood pressure, cholesterol, heart condition, or any other medical condition? *

Yes

No

Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision? *

Yes

No

Are you over the age of 65 and not accustomed to vigorous exercise? *

Yes

No

Have you had any serious injuries or operations including breaks and sprains throughout your life? If yes please give date and information below. *

Yes

No

Have you consulted with your doctor regarding online fitness coaching with - Marc Hector Coaching or performing a fitness assessment? *

Yes

No

If you have not consulted with your doctor, are you prepared to consult with your doctor prior to online fitness with - Marc Hector Coaching and / or providing a medical clearance note? *

Yes

No

By selecting 'I accept', I agree that the information provided in this Physical Activity Readiness Form is correct and should any circumstances change it is my responsibility to inform Marc Hector Coaching *

I Accept

I Don't Accept

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

Yes

No