Physical Activity Readiness Questionnaire to access your readiness to take part in physical activity.

Please read the questions carefully and answer each one honestly, giving details where answering yes.

All information obtained is confidential and follows GDPR guidelines.
Email address *
Name *
Your answer
Date of Birth *
Contact Number *
Your answer
Emergency Contact Person *
Your answer
Emergency Contact Persons Number *
Your answer
Has your doctor ever said that 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 experienced any unexplained chest pain? *
Do you lose your balance due to dizziness or do you ever lose unconsciousness *
Do you have a bone or joint problem that could be made worse by a change in physical activity? *
Is your doctor currently prescribing medication for your blood pressure or a heart condition? *
Do you suffer from asthma? *
Are you currently taking any medication? *
If 'Yes' to medication, please give some details
Your answer
Are you pregnant or have had a baby in the past 6 months? *
Do you know of any other reason why you should not do physical activity or have any condition that may be made worse by physical activity? *
Additional Information
Your answer
If you have answered 'Yes' to any of the questions above, please seek advice from your GP/Doctor unless prior advice has been sought. Should your health status change, please inform us as soon as possible. *
Assumption of Risk and Release of Liability: Participating in any physical fitness activity, I recognise and understand that the services offered is not without varying degrees of risk which may include, but are not limited to financial loss, injury or even death, due to negligence, improper use or failure of equipment, medical condition, whether known or unknown to me. I hereby certify that I know of no medical problems that could increase my risk of illness and injury as a result of participation. *
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