PAR-Q & New Client Forms | Keep Going Fit

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Coaching is for adults 18 and older.

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Health Screening (PAR-Q)

Your answers are used only for coaching and programming. See our Privacy Policy.

1.Has a doctor ever said you have a heart condition and recommended only medically supervised physical activity?

Yes No

2.Do you feel discomfort in your chest during physical activity?

Yes No

3.In the past month, have you had chest discomfort when not doing physical activity?

Yes No

4.Do you lose your balance because of dizziness, or have you lost consciousness in the past 12 months?

Yes No

5.Do you have a bone, joint, or soft-tissue condition that could be made worse by a change in physical activity?

Yes No

6.Is your doctor currently prescribing medication for blood pressure, a heart condition, or diabetes?

Yes No

7.Are you pregnant, or have you given birth within the last 6 months?

Yes No

8.Do you know of any other reason you should not participate in physical activity today?

Yes No

If you answered "Yes" to any question, please explain

This screening tells us whether you should get sign-off from a physician before today's session. It is not a diagnosis, and your coach does not interpret medical findings. A "Yes" answer means we'll recommend physician clearance before proceeding.

Session Waiver & Release

This agreement covers one (1) session only with Keep Going Wellness LLC, DBA Keep Going Fit ("Keep Going Fit"), and does not obligate either party to any ongoing arrangement.

I understand that physical activity, movement assessment, and exercise carry inherent risk, including the risk of injury. I am voluntarily participating with full knowledge of this risk.

I release Keep Going Wellness LLC, its coaches, and its agents from liability for any injury or loss arising from my participation, except in cases of gross negligence.

I confirm the health information I provided above is accurate and complete to the best of my knowledge.

I understand my coach holds NASM certification and operates strictly within that scope — coaching movement, exercise, and general nutrition habits. My coach does not diagnose conditions or provide medical care, and nothing in this session replaces the advice of a licensed physician.

I have read and agree to the release above. *

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