MaxBoxes = 45 MaxChecks = 20 Text1 = PAR Q: Physical Analysis Text1_Left = 15 Text1_Top = 70 Text1_Right = 500 Text1_Bottom = 95 Text1_TxtSize = 300 Text1_TxtRed = 255 Text1_TxtGreen = 255 Text1_TxtBlue = 255 Text1_BackRed = 36 Text1_BackGreen = 130 Text1_BackBlue = 183 ##= // QUESTION 1 Text2 = 1. Have you ever spoken to your Doctor about chest pains or heart issues? Text2_Left = 30 Text2_Top = 115 Text2_Right = 500 Text2_Bottom = 135 Text2_TxtSize = 200 Text2_Bold = 1 Text2_AlignLeft = 1 Text2_BackRed = 255 Text2_BackGreen = 255 Text2_BackBlue = 255 Text2_TxtRed = 0 Text2_TxtGreen = 0 Text2_TxtBlue = 0 ##= //CHECK BOXES - YES & NO Question 1 Check3 = Q1_Check_1 Check3_Left = 46 Check3_Top = 137 Check3_Toggle = 1 Check3_ExcludeChecks = Q1_Check_2 Check3_DataField = HeartTrouble ##= Text3 = Q1_ChkVal_1 Text3_InitVal = Yes Text3_Left = 60 Text3_Top = 135 Text3_Right = 90 Text3_Bottom = 155 Text3_TxtSize = 200 Text3_Bold = 0 Text3_AlignLeft = 1 Text3_SetChecks = Q1_Check_1 Text3_ExcludeChecks = Q1_Check_2 Text3_BackRed = 255 Text3_BackGreen = 255 Text3_BackBlue = 255 Text3_TxtRed = 0 Text3_TxtGreen = 0 Text3_TxtBlue = 0 ##= Check4 = Q1_Check_2 Check4_Left = 112 Check4_Top = 137 Check4_Toggle = 1 Check4_ExcludeChecks = Q1_Check_1 Check4_DataField = !HeartTrouble ##= Text4 = Q1_ChkVal_2 Text4_InitVal = No Text4_Left = 125 Text4_Top = 135 Text4_Right = 150 Text4_Bottom = 155 Text4_TxtSize = 200 Text4_Bold = 0 Text4_AlignLeft = 1 Text4_SetChecks = Q1_Check_2 Text4_ExcludeChecks = Q1_Check_1 Text4_BackRed = 255 Text4_BackGreen = 255 Text4_BackBlue = 255 Text4_TxtRed = 0 Text4_TxtGreen = 0 Text4_TxtBlue = 0 ##= Text32 = Q1_Reason Text32_InitVal = List: Text32_Left = 151 Text32_Top = 135 Text32_Right = 204 Text32_Bottom = 160 Text32_TxtSize = 200 Text32_Bold = 0 Text32_AlignRight = 1 Text32_BackRed = 255 Text32_BackGreen = 255 Text32_BackBlue = 255 Text32_TxtRed = 0 Text32_TxtGreen = 0 Text32_TxtBlue = 0 ##= Text33 = Q1_Heart_Chest Text33_DataField = ParQHeartChest Text33_Left = 205 Text33_Top = 132 Text33_Right = 500 Text33_Bottom = 158 Text33_TxtSize = 200 Text33_Bold = 0 Text33_AlignLeft = 1 Text33_ReadOnly = 0 Text33_Border = 1 Text33_TabStop = 1 Text33_BackRed = 255 Text33_BackGreen = 255 Text33_BackBlue = 255 Text33_TxtRed = 0 Text33_TxtGreen = 0 Text33_TxtBlue = 0 ##= // QUESTION 2 Text5 = 2. Have you ever spoken to your Doctor about bone or joint problems? Text5_Left = 30 Text5_Top = 160 Text5_Right = 490 Text5_Bottom = 180 Text5_TxtSize = 200 Text5_Bold = 1 Text5_AlignLeft = 1 Text5_BackRed = 255 Text5_BackGreen = 255 Text5_BackBlue = 255 Text5_TxtRed = 0 Text5_TxtGreen = 0 Text5_TxtBlue = 0 ##= //CHECK BOXES - YES & NO Question 4 Check7 = Q2_Check_1 Check7_Left = 46 Check7_Top = 182 Check7_Toggle = 1 Check7_ExcludeChecks = Q2_Check_2 Check7_DataField = BoneJoint ##= Text6 = Q2_ChkVal_1 Text6_InitVal = Yes Text6_Left = 60 Text6_Top = 180 Text6_Right = 90 Text6_Bottom = 200 Text6_TxtSize = 200 Text6_Bold = 0 Text6_AlignLeft = 1 Text6_SetChecks = Q2_Check_1 Text6_ExcludeChecks = Q2_Check_2 Text6_BackRed = 255 Text6_BackGreen = 255 Text6_BackBlue = 255 Text6_TxtRed = 0 Text6_TxtGreen = 0 Text6_TxtBlue = 0 ##= Check8 = Q2_Check_2 Check8_Left = 112 Check8_Top = 182 Check8_Toggle = 1 Check8_ExcludeChecks = Q2_Check_1 Check8_DataField = !BoneJoint ##= Text7 = Q2_ChkVal_2 Text7_InitVal = No Text7_Left = 125 Text7_Top = 180 Text7_Right = 150 Text7_Bottom = 200 Text7_TxtSize = 200 Text7_Bold = 0 Text7_AlignLeft = 1 Text7_SetChecks = Q2_Check_2 Text7_ExcludeChecks = Q2_Check_1 Text7_BackRed = 255 Text7_BackGreen = 255 Text7_BackBlue = 255 Text7_TxtRed = 0 Text7_TxtGreen = 0 Text7_TxtBlue = 0 ##= Text34 = Q2_Reason Text34_InitVal = List: Text34_Left = 151 Text34_Top = 185 Text34_Right = 204 Text34_Bottom = 200 Text34_TxtSize = 200 Text34_Bold = 0 Text34_AlignRight = 1 Text34_BackRed = 255 Text34_BackGreen = 255 Text34_BackBlue = 255 Text34_TxtRed = 0 Text34_TxtGreen = 0 Text34_TxtBlue = 0 ##= Text35 = Q2_Bone_Joint Text35_DataField = ParQBoneJoint Text35_Left = 205 Text35_Top = 180 Text35_Right = 500 Text35_Bottom = 206 Text35_TxtSize = 200 Text35_Bold = 0 Text35_AlignLeft = 1 Text35_ReadOnly = 0 Text35_Border = 1 Text35_TabStop = 1 Text35_BackRed = 255 Text35_BackGreen = 255 Text35_BackBlue = 255 Text35_TxtRed = 0 Text35_TxtGreen = 0 Text35_TxtBlue = 0 ##= // QUESTION 3 Text8 = 3. Do you often feel faint or have spells of severe dizziness? Text8_Left = 30 Text8_Top = 205 Text8_Right = 450 Text8_Bottom = 225 Text8_TxtSize = 200 Text8_Bold = 1 Text8_AlignLeft = 1 Text8_BackRed = 255 Text8_BackGreen = 255 Text8_BackBlue = 255 Text8_TxtRed = 0 Text8_TxtGreen = 0 Text8_TxtBlue = 0 ##= CHECK BOXES - YES & NO Question 3 ##= Check9 = Q3_Check_1 Check9_Left = 46 Check9_Top = 227 Check9_Toggle = 1 Check9_ExcludeChecks = Q3_Check_2 Check9_DataField = Dizzy ##= Text9 = Q3_ChkVal_1 Text9_InitVal = Yes Text9_Left = 60 Text9_Top = 225 Text9_Right = 90 Text9_Bottom = 245 Text9_TxtSize = 200 Text9_Bold = 0 Text9_AlignLeft = 1 Text9_SetChecks = Q3_Check_1 Text9_ExcludeChecks = Q3_Check_2 Text9_BackRed = 255 Text9_BackGreen = 255 Text9_BackBlue = 255 Text9_TxtRed = 0 Text9_TxtGreen = 0 Text9_TxtBlue = 0 ##= Check10 = Q3_Check_2 Check10_Left = 112 Check10_Top = 227 Check10_Toggle = 1 Check10_ExcludeChecks = Q3_Check_1 Check10_DataField = !Dizzy ##= Text10 = Q3_ChkVal_2 Text10_InitVal = No Text10_Left = 125 Text10_Top = 225 Text10_Right = 150 Text10_Bottom = 245 Text10_TxtSize = 200 Text10_Bold = 0 Text10_AlignLeft = 1 Text10_SetChecks = Q3_Check_2 Text10_ExcludeChecks = Q3_Check_1 Text10_BackRed = 255 Text10_BackGreen = 255 Text10_BackBlue = 255 Text10_TxtRed = 0 Text10_TxtGreen = 0 Text10_TxtBlue = 0 ##= Text36 = Q3_Reason Text36_InitVal = List: Text36_Left = 151 Text36_Top = 225 Text36_Right = 204 Text36_Bottom = 240 Text36_TxtSize = 200 Text36_Bold = 0 Text36_AlignRight = 1 Text36_BackRed = 255 Text36_BackGreen = 255 Text36_BackBlue = 255 Text36_TxtRed = 0 Text36_TxtGreen = 0 Text36_TxtBlue = 0 ##= Text37 = Q3_Dizzy Text37_DataField = ParQDizzy Text37_Left = 205 Text37_Top = 222 Text37_Right = 500 Text37_Bottom = 248 Text37_TxtSize = 200 Text37_Bold = 0 Text37_AlignLeft = 1 Text37_ReadOnly = 0 Text37_Border = 1 Text37_TabStop = 1 Text37_BackRed = 255 Text37_BackGreen = 255 Text37_BackBlue = 255 Text37_TxtRed = 0 Text37_TxtGreen = 0 Text37_TxtBlue = 0 ##= // QUESTION 4 Text11 = 4. Have you had surgery in the past 6 months? Text11_Left = 30 Text11_Top = 250 Text11_Right = 400 Text11_Bottom = 270 Text11_TxtSize = 200 Text11_Bold = 1 Text11_AlignLeft = 1 Text11_BackRed = 255 Text11_BackGreen = 255 Text11_BackBlue = 255 Text11_TxtRed = 0 Text11_TxtGreen = 0 Text11_TxtBlue = 0 ##= //CHECK BOXES - YES & NO Question 4 Check11 = Q4_Check_1 Check11_Left = 46 Check11_Top = 272 Check11_Toggle = 1 Check11_ExcludeChecks = Q4_Check_2 Check11_DataField = Surgery ##= Text12 = Q4_ChkVal_1 Text12_InitVal = Yes Text12_Left = 60 Text12_Top = 270 Text12_Right = 90 Text12_Bottom = 290 Text12_TxtSize = 200 Text12_Bold = 0 Text12_AlignLeft = 1 Text12_SetChecks = Q4_Check_1 Text12_ExcludeChecks = Q4_Check_2 Text12_BackRed = 255 Text12_BackGreen = 255 Text12_BackBlue = 255 Text12_TxtRed = 0 Text12_TxtGreen = 0 Text12_TxtBlue = 0 ##= Check12 = Q4_Check_2 Check12_Left = 112 Check12_Top = 272 Check12_Toggle = 1 Check12_ExcludeChecks = Q4_Check_1 Check12_DataField = !Surgery ##= Text13 = Q4_ChkVal_2 Text13_InitVal = No Text13_Left = 125 Text13_Top = 270 Text13_Right = 150 Text13_Bottom = 290 Text13_TxtSize = 200 Text13_Bold = 0 Text13_AlignLeft = 1 Text13_SetChecks = Q4_Check_2 Text13_ExcludeChecks = Q4_Check_1 Text13_BackRed = 255 Text13_BackGreen = 255 Text13_BackBlue = 255 Text13_TxtRed = 0 Text13_TxtGreen = 0 Text13_TxtBlue = 0 ##= Text38 = Q4_Reason Text38_InitVal = List: Text38_Left = 151 Text38_Top = 269 Text38_Right = 204 Text38_Bottom = 294 Text38_TxtSize = 200 Text38_Bold = 0 Text38_AlignRight = 1 Text38_BackRed = 255 Text38_BackGreen = 255 Text38_BackBlue = 255 Text38_TxtRed = 0 Text38_TxtGreen = 0 Text38_TxtBlue = 0 ##= Text39 = Q4_SurgerySixMonths Text39_DataField = ParQSurgerySixMonths Text39_Left = 205 Text39_Top = 267 Text39_Right = 500 Text39_Bottom = 292 Text39_TxtSize = 200 Text39_Bold = 0 Text39_AlignLeft = 1 Text39_ReadOnly = 0 Text39_Border = 1 Text39_TabStop = 1 Text39_BackRed = 255 Text39_BackGreen = 255 Text39_BackBlue = 255 Text39_TxtRed = 0 Text39_TxtGreen = 0 Text39_TxtBlue = 0 ##= // QUESTION 5 Text14 = 5. Are you pregnant? Text14_Left = 30 Text14_Top = 295 Text14_Right = 400 Text14_Bottom = 315 Text14_TxtSize = 200 Text14_Bold = 1 Text14_AlignLeft = 1 Text14_BackRed = 255 Text14_BackGreen = 255 Text14_BackBlue = 255 Text14_TxtRed = 0 Text14_TxtGreen = 0 Text14_TxtBlue = 0 ##= //CHECK BOXES - YES & NO Question 5 Check13 = Q5_Check_1 Check13_Left = 46 Check13_Top = 317 Check13_Toggle = 1 Check13_ExcludeChecks = Q5_Check_2 Check13_DataField = Pregnant ##= Text15 = Q5_ChkVal_1 Text15_InitVal = Yes Text15_Left = 60 Text15_Top = 315 Text15_Right = 90 Text15_Bottom = 335 Text15_TxtSize = 200 Text15_Bold = 0 Text15_AlignLeft = 1 Text15_SetChecks = Q5_Check_1 Text15_ExcludeChecks = Q5_Check_2 Text15_BackRed = 255 Text15_BackGreen = 255 Text15_BackBlue = 255 Text15_TxtRed = 0 Text15_TxtGreen = 0 Text15_TxtBlue = 0 ##= Check15 = Q5_Check_2 Check15_Left = 112 Check15_Top = 317 Check15_Toggle = 1 Check15_ExcludeChecks = Q5_Check_1 Check15_DataField = !Pregnant ##= Text16 = Q5_ChkVal_2 Text16_InitVal = No Text16_Left = 125 Text16_Top = 315 Text16_Right = 150 Text16_Bottom = 335 Text16_TxtSize = 200 Text16_Bold = 0 Text16_AlignLeft = 1 Text16_SetChecks = Q5_Check_2 Text16_ExcludeChecks = Q5_Check_1 Text16_BackRed = 255 Text16_BackGreen = 255 Text16_BackBlue = 255 Text16_TxtRed = 0 Text16_TxtGreen = 0 Text16_TxtBlue = 0 ##= // QUESTION 6 Text17 = 6. Is there any reason, not mentioned, that would not allow you to participate in a physical fitness program? Text17_MultiLine = 1 Text17_Left = 30 Text17_Top = 340 Text17_Right = 450 Text17_Bottom = 375 Text17_TxtSize = 200 Text17_Bold = 1 Text17_AlignLeft = 1 Text17_BackRed = 255 Text17_BackGreen = 255 Text17_BackBlue = 255 Text17_TxtRed = 0 Text17_TxtGreen = 0 Text17_TxtBlue = 0 ##= //CHECK BOXES - YES & NO Question 6 Check16 = Q6_Check_1 Check16_Left = 46 Check16_Top = 378 Check16_Toggle = 1 Check16_ExcludeChecks = Q6_Check_2 Check16_DataField = OtherCondition ##= Text18 = Q6_ChkVal_1 Text18_InitVal = Yes Text18_Left = 60 Text18_Top = 376 Text18_Right = 90 Text18_Bottom = 396 Text18_TxtSize = 200 Text18_Bold = 0 Text18_AlignLeft = 1 Text18_SetChecks = Q6_Check_1 Text18_ExcludeChecks = Q6_Check_2 Text18_BackRed = 255 Text18_BackGreen = 255 Text18_BackBlue = 255 Text18_TxtRed = 0 Text18_TxtGreen = 0 Text18_TxtBlue = 0 ##= Check17 = Q6_Check_2 Check17_Left = 112 Check17_Top = 378 Check17_Toggle = 1 Check17_ExcludeChecks = Q6_Check_1 Check17_DataField = !OtherCondition ##= Text19 = Q6_ChkVal_2 Text19_InitVal = No Text19_Left = 125 Text19_Top = 376 Text19_Right = 150 Text19_Bottom = 396 Text19_TxtSize = 200 Text19_Bold = 0 Text19_AlignLeft = 1 Text19_SetChecks = Q6_Check_2 Text19_ExcludeChecks = Q6_Check_1 Text19_BackRed = 255 Text19_BackGreen = 255 Text19_BackBlue = 255 Text19_TxtRed = 0 Text19_TxtGreen = 0 Text19_TxtBlue = 0 ##= Text40 = Q6_Reason Text40_InitVal = List: Text40_Left = 151 Text40_Top = 377 Text40_Right = 204 Text40_Bottom = 394 Text40_TxtSize = 200 Text40_Bold = 0 Text40_AlignRight = 1 Text40_BackRed = 255 Text40_BackGreen = 255 Text40_BackBlue = 255 Text40_TxtRed = 0 Text40_TxtGreen = 0 Text40_TxtBlue = 0 ##= Text41 = Q6_NotMentioned Text41_DataField = ParQNotMentioned Text41_Left = 205 Text41_Top = 373 Text41_Right = 500 Text41_Bottom = 398 Text41_TxtSize = 200 Text41_Bold = 0 Text41_AlignLeft = 1 Text41_ReadOnly = 0 Text41_Border = 1 Text41_TabStop = 1 Text41_BackRed = 255 Text41_BackGreen = 255 Text41_BackBlue = 255 Text41_TxtRed = 0 Text41_TxtGreen = 0 Text41_TxtBlue = 0 ##= Text20 = IF YOU ANSWERED "YES" TO ANY OF THE ABOVE QUESTIONS, PLEASE ANSWER AND INITIAL THE FOLLOWING QUESTION. Text20_Bold = 0 Text20_MultiLine = 1 Text20_Left = 30 Text20_Top = 401 Text20_Right = 450 Text20_Bottom = 436 Text20_TxtSize = 200 Text20_AlignLeft = 1 Text20_BackRed = 255 Text20_BackGreen = 255 Text20_BackBlue = 255 Text20_TxtRed = 0 Text20_TxtGreen = 0 Text20_TxtBlue = 0 ##= // QUESTION 7 Text21 = 7. Have you consulted your physician regarding an increase in physical activity and/or receiving a fitness evaluation or fitness program? Also, please list any medications and injuries: Text21_MultiLine = 1 Text21_Left = 30 Text21_Top = 441 Text21_Right = 500 Text21_Bottom = 491 Text21_TxtSize = 200 Text21_Bold = 1 Text21_AlignLeft = 1 Text21_BackRed = 255 Text21_BackGreen = 255 Text21_BackBlue = 255 Text21_TxtRed = 0 Text21_TxtGreen = 0 Text21_TxtBlue = 0 ##= Check18 = Q7_Check_1 Check18_Left = 46 Check18_Top = 504 Check18_Toggle = 1 Check18_ExcludeChecks = Q7_Check_2 Check18_DataField = ConsultPhysician ##= Text22 = Q7_ChkVal_1 Text22_InitVal = Yes Text22_Left = 61 Text22_Top = 502 Text22_Right = 90 Text22_Bottom = 522 Text22_TxtSize = 200 Text22_Bold = 0 Text22_AlignLeft = 1 Text22_SetChecks = Q7_Check_1 Text22_ExcludeChecks = Q7_Check_2 Text22_BackRed = 255 Text22_BackGreen = 255 Text22_BackBlue = 255 Text22_TxtRed = 0 Text22_TxtGreen = 0 Text22_TxtBlue = 0 ##= Check19 = Q7_Check_2 Check19_Left = 112 Check19_Top = 504 Check19_Toggle = 1 Check19_ExcludeChecks = Q7_Check_1 Check19_DataField = !ConsultPhysician ##= Text23 = Q7_ChkVal_2 Text23_InitVal = No Text23_Left = 126 Text23_Top = 502 Text23_Right = 150 Text23_Bottom = 522 Text23_TxtSize = 200 Text23_Bold = 0 Text23_AlignLeft = 1 Text23_SetChecks = Q7_Check_2 Text23_ExcludeChecks = Q7_Check_1 Text23_BackRed = 255 Text23_BackGreen = 255 Text23_BackBlue = 255 Text23_TxtRed = 0 Text23_TxtGreen = 0 Text23_TxtBlue = 0 ##= Text30 = Q7_Reason Text30_InitVal = List: Text30_Left = 151 Text30_Top = 502 Text30_Right = 204 Text30_Bottom = 522 Text30_TxtSize = 200 Text30_Bold = 0 Text30_AlignRight = 1 Text30_BackRed = 255 Text30_BackGreen = 255 Text30_BackBlue = 255 Text30_TxtRed = 0 Text30_TxtGreen = 0 Text30_TxtBlue = 0 ##= Text24 = Q7_Injuries_Meds Text24_DataField = OtherMedical Text24_Left = 205 Text24_Top = 497 Text24_Right = 500 Text24_Bottom = 522 Text24_TxtSize = 200 Text24_Bold = 0 Text24_AlignLeft = 1 Text24_ReadOnly = 0 Text24_Border = 1 Text24_TabStop = 1 Text24_BackRed = 255 Text24_BackGreen = 255 Text24_BackBlue = 255 Text24_TxtRed = 0 Text24_TxtGreen = 0 Text24_TxtBlue = 0 ##= // INITIAL BOXES & TEXT Text25 = Initials Text25_Border = 1 Text25_DataField = Initials_ParQ Text25_Required = 1 Text25_Left = 100 Text25_Top = 555 Text25_Right = 150 Text25_Bottom = 580 Text25_TxtSize = 200 Text25_Bold = 1 Text25_TxtRed = 0 Text25_TxtGreen = 0 Text25_TxtBlue = 0 Text25_BackRed = 255 Text25_BackGreen = 255 Text25_BackBlue = 255 Text25_Operand = 1 Text25_ReadOnly = 0 Text25_TabStop = 1 Text25_TxtRed = 0 Text25_TxtGreen = 0 Text25_TxtBlue = 0 ##= Text26 = InitTxt1 Text26_InitVal = IF YOU HAVE READ AND AGREE, PLEASE INITIAL BELOW: Text26_Left = 30 Text26_Top = 534 Text26_Right = 400 Text26_Bottom = 554 Text26_TxtSize = 200 Text26_AlignLeft = 1 Text26_Bold = 1 Text26_TxtGreen = 0 Text26_TxtGreen = 0 Text26_TxtBlue = 0 Text26_BackRed = 255 Text26_BackGreen = 255 Text26_BackBlue = 255 Text26_TxtRed = 0 Text26_TxtGreen = 0 Text26_TxtBlue = 0 ##=