Physical Activity Readiness Questionnaire. (PAR-Q)


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 your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor. Common sense is your best guide when answering these questions. Please read the eight questions carefully and answer each one honestly. Check YES or NO.
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D.O.B *
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Name *
Email *
Address
Phone number *
1. Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? *
Required
2. Do you feel pain in your chest when you do physical activity? *
Required
3. In the past month, have you had chest pain when you were not doing physical activity? *
Required
4. Do you lose balance because of dizziness or do you ever lose consciousness? *
Required
5. 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? *
Required
6. Is your doctor currently prescribing medication for your blood pressure or a heart condition? *
Required
7. Are you pregnant or have you given birth in the last six months? *
Required
8. Do you know of any other reasons why you should not do physical activity? *
Required
If you answered YES to any of the above questions please describe in more detail as to why you answered "yes".
If you answered YES to one or more questions then: You are advised to consult with your doctor to clarify if 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 questions: It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level.
"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. By selecting 'Agree' it will act as my signature on this Physical Activity Readiness Questionnaire." *
"Having answered YES to one or more of the above, I have sought medical advice and my GP has agreed that I may exercise. By selecting 'Agree' it will act as my signature on this Physical Activity Readiness Questionnaire."
Full Name and Date- day/month/year *
Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the 8 questions.
A copy of your responses will be emailed to the address you provided.
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