Responses cannot be edited
PAR-Q Activity Readiness Questionnaire
PAR-Q is designed to help you help yourself. Completing a 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 has been 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 your best guide in answering these few questions.

Name, First & Last
Age
Date of Last Physical
MM
/
DD
/
YYYY
Please read each question carefully and check YES or NO.
If YES, please explain.
1. Has your physician ever said you have heart trouble?
If yes, please explain.
2. Do you frequently have pains in your heart and chest?
If yes, please explain.
3. Do you often feel faint or have spells of severe dizziness?
If yes, please explain.
4. Has a physician ever said your blood pressure was too high?
If yes, please explain.
5. Has your physician ever told you that you have a bone or joint problem such as arthritis that has been aggravated?
If yes, please explain.
6. Is there any other reason not mentioned here that may put you at risk during exercise that we should know?
If yes, please explain.
7. Are you over 45 years old and NOT accustomed to vigorous exercise?
If yes, please explain.
8. Do you suffer from any problems of the lower back, chronic pain, or numbness?
If yes, please explain.
9. Do you have a disability?
If yes, please explain.
10. Do you have a communicable disease that could affect others?
If yes, please explain.
11. Are you a cancer survivor?
If yes, for how long?
12. Are you presently in treatment for cancer or any other health issue?
If yes, please explain.
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Additional Terms