Book a Trial - Viva Buckingham

Small Group PT - 22/04/2026 17:15

Full Name

Email address

Phone number

Date of birth

Country

Legal Documents

VIVA Gym Buckingham - PAR-Q

Please answer the following health questionnaire as accurately has possible so that we are best placed to support you on your fitness journey at VIVA!

If you have any questions, please ask one of the coaching team or email info@vivabuckingham.co.uk

Have you had a Major Injury &/or Illness within the last 5-years?

Yes

Have you ever been diagnosed with any chronic medical condition?

Yes

Are you currently taking prescribed medication?

Yes

Are you currently pregnant or have you had a baby in the past 6 months?

Yes

Do you have any injuries, pain or discomfort that impact you day to day or when you exercise?

Do you have any specfic health and fitness goals that you would like support with?

Please sign to confirm you have completed your PAR-Q health questionnaire as accurately as possible.

Viva Buckingham can contact me with relevant promotional content