Health & Fitness Readiness Form

Client Information

Full Name

Date of Birth

Phone Number

Address

Emergency Contact Name & Phone

Primary Care Physician (if applicable)

Are you a U.S. veteran?

Yes No

Physical Activity Readiness (PAR-Q)

Answer YES or NO to each question. If you answer YES to one or more questions, consult your physician before beginning a fitness program. Note: this is a screening tool, not a medical clearance.

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

Yes No

Do you feel pain in your chest when you perform physical activity?

Yes No

In the past month, have you had chest pain when you were not performing any physical activity?

Yes No

Do you lose your balance because of dizziness, or do you ever lose consciousness?

Yes No

Do you have a bone or joint problem (e.g., back, knee, hip) that could be worsened by a change in your physical activity?

Yes No

Is your doctor currently prescribing medication for your blood pressure or a heart condition?

Yes No

Do you know of any other reason why you should not engage in physical activity?

Yes No

Health History

Current medications (list all)

Known injuries, surgeries, or chronic conditions

Current activity level

Mostly sedentary — little to no regular exercise Light activity — occasional walks, light movement Moderate — some regular exercise (1–2x/week) Active — regular exercise 3+ times/week

Primary fitness goal(s)

Anything else April should know before your first session?

Informed Consent & Liability Waiver

Please read carefully before signing.

I understand that participation in a fitness program involves physical exertion and inherent risk of injury. I acknowledge that April Previti / Epic Veteran Mobility LLC is an ISSA-certified personal trainer, not a licensed physical therapist, physician, or medical provider, and that the services provided are fitness training — not medical treatment, physical therapy, or rehabilitation.

I confirm that I have answered the above questions honestly and to the best of my knowledge. I agree to immediately inform April of any changes in my health status. I voluntarily choose to participate and assume all risks associated with physical fitness activities.

In consideration of the services provided, I release Epic Veteran Mobility LLC and April Previti from any and all claims, demands, or causes of action arising out of participation in fitness training, except those caused by gross negligence or willful misconduct.

I understand that Epic Veteran Mobility LLC carries professional and general liability insurance. This waiver does not limit rights beyond what is permitted under Tennessee law.

Client Signature

Date

Printed Name

For Trainer Use Only

Session start date

Trainer notes / modifications

Trainer Signature (April Previti, ISSA-CPT)

Date

Epic Veteran Mobility — PAR-Q & Client Intake

Client Information

Physical Activity Readiness (PAR-Q)

Health History

Physician Clearance

Informed Consent & Liability Waiver

For Trainer Use Only