1-2-1 Coaching Form

1-2-1 Coaching Questionnaire

For most people, physical activity should not pose any problems or hazard. This form has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.

If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.

PERSONAL DETAILS


HEALTH & FITNESS

DIET & NUTRITION

5
1 being "NOT GREAT" and 5 being "BEST SHAPE OF MY LIFE"

MEDICAL

If you answered YES to one or more medical questions:
You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health

If you answered NO to one or more medical questions:
It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help you determine your ability levels.

Please read the BFunctional Client-Coach Agreement here.