Member Portal

P.A.R.Q ASSESMENT

Are you interested in signing up for the LIFT program?

Fill out this P.A.R.Q ASSESMENT

Then SCHEDULE YOUR CONSULTATION

A LIFT Coach will reach out to you !

LIFT

Client's information

Name
Name
First Name
Last Name

Emergency Contact

Emergency Contact Name
Emergency Contact Name
First Name
Last Name

General Medical Information

Check the symptoms that you' re currently experiencing:
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Do you know of any other reason why you should not do physical activity?
Are you currently taking any medications?
Have you had surgery within the last 6 months?
Are you currently under PT or medical treatment?
Are you currently pregnant?
How often do you consume alcohol?

General Activity Information

Do you experience pain in any of these locations?
Does your occupation require long periods of sitting?
Does your occupation require repetitive movement?
Do you partake in any recreational activities (golf, skiing, ect)?
Do you have any additional hobbies (reading, video games, ect)?
Have you been exercising for the past 6 months?

Fitness Goals

What are your fitness goals?
How many times per week can you dedicate to working out?
Start Over