Physical Activity Readiness Questionnaire (PAR-Q)
If you are planning to become much more physically active than you are now, start by answering the seven following questions. 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 start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.
Email address *
Your Name *
Your answer
Please answer the following:
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly; click on each one YES or NO.
1.Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
2. Do you feel pain in your chest when you do physical activity? *
3. In the past month, have you had chest pain when you were not doing physical activity? *
4. Do you lose your balance because of dizziness or do you ever lose consciousness? *
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? *
6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *
7. Do you know of any other reason you should not do physical activity? *
If you have answered Yes to 7. (above), please comment:
Your answer
Yes to one or more questions?
You should consult 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.
No to all questions?
You can be reasonably sure that it is safe for you to participate in physical activity, gradually building up from your current ability level. A full fitness appraisal can help to determine your fitness.
Disclaimer:
“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.”
Client Name: *
Your answer
Client Signature:
(A copy of this PAR-Q will be presented to you to sign at your first appointment).
Your answer
Date:
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Trainer's Name:
(To be completed at your first appointment.)
Your answer
Trainer's Signature:
(To be completed at your first appointment.)
Your answer
Date:
MM
/
DD
/
YYYY
Having answered YES to one of the above?
“Having answered YES to one of the above, I have sought medical advice and my GP has agreed that I may exercise.”
Client Signature:
Your answer
Please 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 7 questions.
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