Physical Activity Readiness Questionnaire (PAR-Q)
Do you have a heart condition or cardiovascular disorder?
Yes
No
Did the doctor advised you to limit physical activity and only perform the recommended activities by the professional?
Yes
No
Is there any chest pain when your doing any physical activity?
Yes
No
In the past month, did you experience any pain in the chest area when you're not doing anything?
Yes
No
Do you usually lose your balance due to being dizzy or even lose your consciousness?
Yes
No
Are you experiencing bone or joint problems that worsens if you change your physical activity?
Yes
No
Are you currently taking medications for your blood pressure or heart condition?
Yes
No
Is there any reason why you should not do physical activities?
Yes
No
If you're answer is "NO" to all of the questions above, then you are safe to participate in physical activities. If you answer "YES" to one or more questions, then you need to consult your doctor to clarify if you're capable of doing physical activities on your current state.
Personal Information
Name
First Name
Last Name
Gender
Male
Female
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Emergency Contact Person
First Name
Last Name
Emergency Contact Person No.
-
Area Code
Phone Number
Height
Weight
What are your fitness goals?
Signature
Submit
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