PAR-Q (short version)

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Physical Activity Readiness Questionnaire

Email *

Easy2Health collects personal information when you register with us. We will use this information to provide the products and services requested. We will not share your information for marketing purposes with companies outside of Easy2Health. We archive information for 12 months. After 12 months or if information is changed, easy2health will delete any digital or paper information. You always have the right to change, view or request deletion of your personal data. For more information about how we use your information, please see our privacy policy.*
* www.easy2health.co.uk/legals-downloads/privacy-policy

Personal Data

Contact details

Your full name *

DoB *

YYYY

Address *

Phone *

Emergency Contact Details [ Name/ contact number] *

Risk Assessment and Contact Tracing Agreement*

*https://www.easy2health.co.uk/legals-downloads/trainer-client-agreement

I have read through the Risk Assessment and Contact Tracing Agreement thoroughly and agree to all terms. *

Yes

Required

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? *

YES

Required

Do you feel pain in your chest when you do physical activity? *

YES

Required

In the past month, have you had chest pain when you were not doing physical activity? *

YES

Required

Do you lose balance because of dizziness or do you ever lose consciousness? *

YES

Required

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? *

YES

Required

Is your doctor currently prescribing medication for your blood pressure or heart condition? *

YES

Required

Do you know of any other reason why you should not take part in physical activity? *

YES

Required

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 ALL 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. *

YES

Required

Having answered YES to one of the questions above, I have sought medical advice and my GP has agreed that I may exercise. *

YES

I Didn't answered YES to any of medical questions

Required

Where did you hear about us?

NOTE:

This PAR - Q becomes invalid should your condition change.

Send me a copy of my responses.

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