PAR-Q
Physical Active Readiness Questionnaire

Prior to participating in any fitness appraisal, workshop or other routine you are required to complete this PAR-Q together with the informed consent release and waiver form. For most people, physical activity should not pose any problem or hazard, however, potential risks, whilst not apparent at rest, may be exacerbated by an increase in levels of physical activity. The PAR-Q is designed to identify the small number of adults for whom physical activity might be inappropriate or those who +should seek medical advice concerning the type of activity most suitable for them. Please complete the questionnaire below by reading each question carefully and ticking the response that applies to you. You are wholly responsible for your answers and if you are in any doubt you must seek medical advice.
Email *
Name
Date of birth
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Email
Allergies
Phone Number
Has your doctor ever said that you have a bone or joint problem, such as arthritis, or any medical condition, surgical operation or injury that has been aggravated by exercise or might be made worse with exercise?
Do you have high blood pressure?
Do you have low blood pressure?
Do you have Diabetes Mellitus or any other metabolic disease?
Has your doctor ever said you have raised cholesterol (serum level above 6.2mmol/L)?
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Have you ever felt pain in your chest when you do physical exercise or at rest?
Is your doctor currently prescribing you drugs or medication?
Have you ever suffered from unusual shortness of breath at rest or with mild exertion?
Is there any history of coronary heart disease in your family?
Do you often feel faint, have spells of severe dizziness or have you ever lost consciousness?
Do you currently drink more than the average amount of alcohol per week (14 units)?
Do you suffer from regular headaches, dizziness, fainting or fits?
Do you currently exercise on a regular basis (at least 3 times a week) and/or work in a job that is physically demanding?
Are you, or is there any possibility that you might be pregnant?
Do you know of any other reason why you should not participate in a programme of physical activity?
Is there any further information you feel your instructor should be aware of?
If you answered yes to any of the above, please provide details below:
If you answered YES to one or more questions: You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health. If you answered NO to one or more questions:It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels.By signing this PAR-Q I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.Having answered YES to one of the questions above, I have sought medical advice and my GP has agreed that I may exercise.
Today's Date
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Client Signature
Trainer Signature
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