Physical Activity Readiness Questionnaire (PARQ) for JPPT Clients
If you are between the ages of 15 and 69, your answers to this questionnaire will tell you if you should check with your GP before you significantly change your physical activity patterns.

 If you are over 69 years of age and are not used to being very active, please check with your GP before engaging in any strenuous exercise.

 Common sense is your best guide when answering these questions.

 Please read carefully and answer each one honestly: check YES or NO.

1. Do you currently, or have you ever had a medical condition that may affect your ability to take part in physical activity? *
Required
2. In the last 12 months have you undergone any type of surgery? *
Required
3. Do you have a bone, joint, or muscular problem (for example back, knee, or hip pain) that could be made worse by a change in your physical activity? *
Required
4. Are you currently taking any prescription or non-prescription medication? *
Required
5. Do you ever feel pain or tightness in your chest when you do physical activity? *
Required
6. In the past month, have you had chest pain when you were not doing physical activity? *
Required
7. Do you ever lose your balance because of dizziness, or do you ever feel faint or lose consciousness? *
Required
8. Do you know of any other condition that might adversely affect you while you are participating in physical activity? *
Required
If you answered YES to any question, please provide more details:
Your answer
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