Fitness Assessment Questionnaire

All information received on this form will be treated strictly confidential. Please fill out the form completely and accurately. This information is essential to helping your trainer develop a program that addresses your needs, goals, and interests in a safe and effective manner.

Contact/General Information:

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Physician's Address

PAR-Q Form - Please select Yes or No to the following:

If you answered YES to one or more of the PAR-Q questions:

- Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.
- A medical release must be signed by your doctor and submitted to LAVA 24 Fitness before participating in any Group Exercise, LAVA Training, Small Group Personal Training, or Personal Training sessions.
- Please have your doctor send the medical release to the Director of Fitness, Anna Schwartz, at 811 William Hilton Pkwy, Hilton Head Island, SC 29928, or via email at

If you answered NO to all PAR-Q questions:

You can be reasonably sure that you can start becoming much more physically active - begin slowly and build up gradually. This is the safest and easiest way to go.

Lifestyle Related Questions:

List your 3 biggest sources of stress:

Nutrition Related Questions:

List 3 areas of your Nutrition you would like to improve:

Exercise Related Questions:

Please list in order of priority, the fitness goals you would like to achieve in the next 3-12 months:

Outline 3 methods that you plan to use to overcome these obstacles:

Miscellaneous Questions:

Unused Content:

"Great gym!! Staff very friendly! Visit here every year on vacation! Great equipment I don't have at home! Enjoyed my workout!"
- Jill A.