Pre-activity Readiness Questionnaire (PARQ)

Weight-Loss Coaching

Personal Details

Full Name *

Address *

City *

Postal code

Country *

Phone *

Email *

Date of birth *

To assist in planning your session, please indicate your time zone

Emergency Contact-Name *

Emergency Contact-Number *

Gender Identity *

Please indicate your availability/preferred times for appointment

Your Weight Loss Journey.........so far!

What is your height? *

What is your current weight? *

Why do you want to lose weight? *

Have you tried to lose weight before? What methods have you tried? Were you successful? *

What are your weight loss goals? You may have a specific number in mind, but it may also be something like fitting into a favourite item of clothing or being ready for a special event. *

Have you participated in any of our "Sustainable Weight Loss" courses? If so, which? *

Are you aware of any medical reason why you should not participate in a weight loss program? If you are in any doubt about this, we suggest that you consult with a medical professional before commencing. *