Start your Induction

To book an induction at Viavi:be, please fill in the PAR Q form below. Once you have filled in the form, you will be able to book your Viavi:be induction slot. Inductions will only be available on a Sunday

For the safety of others, please do not come into the gym if you have:

Been in contact with someone under investigation for or with a confirmed case of Coronavirus in the last 21 days
If you have a temperature above 37.5 C.
If you have a cough, shortness of breath, loss of smell or taste, chills, muscle pains, headaches or sore throat.

PAR Q form

Your Name*
First Last
Health Coach*
Date*
Date Format: DD slash MM slash YYYY
01. Has your GP ever said you have heart trouble and that you should only do supervised physical activity recommended by an expert?
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
02. Have you ever felt unexplained pains in your chest when exercising or at rest?
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
03. Do you often feel faint or have spells of severe dizziness, get out of breath easily or wake up breathless at night?
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
04. Are you currently receiving or have you ever received treatment for epilepsy?
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
05. Have you ever been diagnosed as diabetic or do you take medicine to control your blood sugar?
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
06. Have you ever been diagnosed with a bone or joint problem such as arthritis that could be made worse by exercising?
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
07. Has your blood pressure ever been raised when measured by your GP?
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
08. Are you taking any medication prescribed by your GP for your blood pressure, a heart condition or other serious illness?
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
09. Do you ever experience shortness of breath at rest or with mild exertion (including asthma)?
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
10. Are you pregnant? (If you become pregnant you should inform us)
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
11. Is there a good reason not mentioned above, why you should not commence a normal exercise programme at Viavi?
- Yes
- No
If yes, have you explained this to your GP and they confirm you are okay to exercise?
- Yes
- No
12. Current medications:
Please include name of medication, dosage & what it is for
Height
Body Fat (kg)
Blood Pressure
Eumotus Score
Weight
FFM (kg)
Visceral Fat
Grip Strength
Bone Mass
Body Fat %
Hydration
Batak Score
Your Details:
Name*
First Last
Phone Number*
Date of Birth*
Date Format: DD slash MM slash YYYY
Email address*
Address*
Address Line 1 Address Line 2 City Postcode
Confirmation*
I confirm by ticking this box that all the information provided to Viavi:be is correct at the time of asking.
Date*
Date Format: DD slash MM slash YYYY

Start your Induction

For the safety of others, please do not come into the gym if you have:

PAR Q form

Your Details: