Physical Activity Readiness Questionnaire (PAR-Q)
CLIENT INFORMATION
Name:
Age:
Height:
Weight:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
Yes
No
Do you feel pain in your chest when you perform physical activity?
Yes
No
In the past month, have you had chest pain when you were not performing any physical activity?
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Yes
No
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
Yes
No
Do you know of any other reason why you should not engage in physical activity?
Yes
No
Occupational
What is your current occupation?
Does your occupation require extended periods of sitting?
Yes
No
Does your occupation require repetitive movements?
Yes
No
If yes, please explain.
Does your occupation require you to wear shoes with a heel (e.g., dress shoes)?
Yes
No
Does your occupation cause you mental stress?
Yes
No
Recreational
Do you partake in any recreational physical activities (golf, skiing, etc.)?
Yes
No
If yes, please explain.
Do you have any additional hobbies (reading, video games, etc.)?
Yes
No
If yes, please explain.
Medical
Have you ever had any injuries or chronic pain?
Yes
No
If yes, please explain.
Have you ever had any surgeries?
Yes
No
If yes, please explain.
Has a medical doctor ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes?
Yes
No
If yes, please explain.
Are you currently taking any medication?
Yes
No
If yes, please explain.
Please list any additional health related information that your trainers should know about.
Submit
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