Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Fitness & Wellness Request Form - Personal/Partner Training or Pilates Reformer

  1. Erie E Graphics FITNESS
  2. Fitness and Wellness Request Form
    Please complete this form if you are interested in participating in Personal Training, Partner Training, Small Group Training or Pilates Reformer.
  3. I am interested in participating in:*
  4. Participant Information
  5. Additional Participant Information (if applicable)
  6. Trainer/Instructor Preference
  7. List times/days
  8. List goals below
  9. Current Physical Activity Level
  10. How many days per week do you exercise?*
  11. How many minutes do you spend exercising per workout?*
  12. Where do you exercise?*
  13. Why do you exercise?*
  14. Are you involved in a structured fitness program?*
  15. Have you had an InBody 570 body composition scan?
  16. PAR-Q (Physical Activity Readiness Questionnaire)
    For most people physical activity should not pose any problem or hazard. The Physical Activity Readiness Questionnaire 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. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly.
  17. PARTNER #1
  18. PARTNER #2
  19. Question 1*
    Has your doctor ever said you have a heart condition AND that you should only do physical activity recommended by a doctor?
  20. Question 1
    Has your doctor ever said you have a heart condition AND that you should only do physical activity recommended by a doctor?
  21. Question 2*
    Do you feel pain in your chest when you do physical activity?
  22. Question 2
    Do you feel pain in your chest when you do physical activity?
  23. Question 3*
    In the past month, have you had chest pain when you were not doing physical activity?
  24. Question 3
    In the past month, have you had chest pain when you were not doing physical activity?
  25. Question 4*
    Do you lose your balance because of dizziness or do you ever lose consciousness?
  26. Question 4
    Do you lose your balance because of dizziness or do you ever lose consciousness?
  27. Question 5*
    Do you have a bone or joint problem that could be made worse by a change in your physical activity?
  28. Question 5
    Do you have a bone or joint problem that could be made worse by a change in your physical activity?
  29. Question 6*
    Is your doctor currently prescribing drugs (for example: water pills) for your blood pressure or heart condition?
  30. Question 6
    Is your doctor currently prescribing drugs (for example: water pills) for your blood pressure or heart condition?
  31. Question 7*
    Do you know of ANY OTHER REASON why you should not do physical activity?
  32. Question 7
    Do you know of ANY OTHER REASON why you should not do physical activity?
  33. If you answered YES to questions 1, 2, 3, 4 or 7...
    Talk with your doctor and have them fill out a Report of Physical Examination form (available at Guest Service) BEFORE you participate in a personal fitness training or fitness assessment. Tell your doctor about the PAR-Q and which questions you answered yes to.
  34. If you answered NO to all of the questions you can reasonably be sure that you can...
    Start becoming more physically active, beginning slowly and building up gradually. This is the safest and easiest way to go. Take part in personal fitness trainer or fitness assessment appointment; this is an excellent way to determine your basic fitness so you can plan the best way for you to live actively. You should delay becoming more physically active if you are not feeling well because of temporary illness such as a cold or fever OR if you are or may be pregnant. Please consult your physician before coming physically active.
  35. Health History Questionnaire
  36. Have you ever had any of the following?
  37. Have you ever had an injury, surgery, or problem with any of the following areas?*
  38. Leave This Blank:

  39. This field is not part of the form submission.