Request edit access
Field Fit PAR - Q
Many health benefits are associated with regular exercise, and the completion of PAR-Q is a sensible first step to take if you are planning to increase the amount of physical activity in your life.
For most people physical activity should not pose any problem or hazard. PAR-Q is 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 the best guide in answering these few questions.
Email address *
Clients Name - *
DOB - *
MM
/
DD
/
YYYY
Address - *
Gender - *
Phone -
What are your main reasons for starting a fitness programme?
If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly
change you physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.
Please read each question carefully and answer honestly by indicating YES or NO.
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? *
Do you feel pain in your chest when you do physical activity? *
In the past month, have you had a chest pain when you were not doing physical activity? *
Do you lose balance because of dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem ( for example back, knee or hip) that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing medication for your blood pressure or heart condition? *
Do you know of any other reason why you should not take part in physical activity?
If YES, please comment:
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 any of the 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.
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.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service