FITNESS CONSULTATION FORM

 

Gender
MaleFemale

Health Check (PAR-Q & You)

Do you have, or have you had:

Heart disease
YesNo
High blood pressure
YesNo

High cholesterol
YesNo

Diabetes
YesNo

Lung disorder (e.g. Asthma, Emphysema)
YesNo

Other disorders
YesNo

Do you feel pain in your chest when you do physical activity?
YesNo

Do you lose balance because of dizziness or have you lost consciousness in the past 12 months?
YesNo

Are you pregnant/ planning to get pregnant?
YesNo

Have you experience any joint pain (requiring treatment) in the last 6 months? (E.g. neck pain, back pain)
YesNo

Have you experience any unusual muscular pain in the last 6 months?
YesNo

Are you currently taking any prescribed medications?
YesNo

Has your doctor ever advised you against exercise for any reason?
YesNo

Lifestyle questions

Have you ever smoked?
YesNo

Currently smoke?
YesNo

Diet & Nutrition

When do eat your meals?



How often do you eat out?

Do you drink alcohol?
YesNo


Exercise history






Fitness Goals


Fitness Goals
Fat LossFirming & ToningMuscle BuildingStress ReliefGeneral WellbeingMindfulnessImproved CardiovascularImproved Flexibility/MovementMuscular StrengthMuscular EnduranceRehabilitationSport Specific


I hereby acknowledge that I have completed this health assessment form correctly and have stated any medical conditions which may restrict my ability to participate in this exercise program. I fully understand that my participation in any Exercise Program, Fitness Test and/or activity at the Beach Club facilities is at my own risk and my own responsibility, and will not hold Katara Beach Club by LivNordic Spa & Wellness and its affiliates responsible for damages to myself which may arise as a result of my participation.


 

GET IN TOUCH
Telephone: +974 4408 1580
Reservations@katara-livnordic.com
www.katara-livnordic.com

LOCATION
Katara Beach Club by LivNordic
Off Shakespeare Street
Katara Cultural Village
Doha, Qatar

HOURS OF SERVICES
Spa Opening hours: 6am – 10pm
Fitness Opening hours: 10am – 10pm

Katara Beach Club by LivNordic © 2017