Online PARQ | Welcome to Movement!

Getting to know you

Please fill out the following form to help me understand how I can best support you !

First Name

Email Address

Last Name

Date of Birth

Name on Facebook? (So I can contact you)

Fav workout song?

The following questions are used to identify if it is safe for you to commence unsupervised exercise. Your responses also help me to accommodate any injuries or medical conditions you may have with tailored exercises to suit your needs.

Please read the questions carefully and answer each one to the best of your knowledge.

Do you have a bone or joint problem that could be made worse by participating in exercise?

Yes

Post partum specific: Please select any option that applies to you

Is there anything else that may impact your ability to participate in physical activity? i.e Injuries, other medical conditions etc.

Do you have any questions or comments?

I declare that the info I’ve provided is accurate & complete to the best of my knowledge

I agree to the terms & conditionsView terms of use

Your Signature

Thanks for submitting!