PAR-Q

Name

DOB

Date

Contact No.

Email

Next of kin

Contact No.

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?

YesNo

Do you ever feel pain in your chest when you do physical activity?

YesNo

Have you ever had chest pain when you were not doing physical activity?

YesNo

Do you ever feel faint or have spells of dizziness?

YesNo

Do you have a joint problem that could be made worse by exercise?

YesNo

Have you ever been told that you have high blood pressure?

YesNo

Are you currently taking any medication of which the instructors should be made aware?

YesNo

If yes, what?

Are you pregnant or have you had a baby in the last six months?

YesNo

Is there any other reason why you should not participate in physical activity?

YesNo

If yes, what?

If you have answered ‘YES’ to one or more questions: Talk to your doctor by phone or in person before you start becoming more physically active and before you have a fitness assessment. Tell your doctor about the questionnaire and which question(s) you answered yes to. You may be able to do any activity you want – as long as you begin slowly and build up gradually – or you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kind of activity you wish to participate in and follow his/her advice.

If you have answered ‘NO’ to all questions: You can be reasonably sure that you can start to become more physically active and take part in a suitable exercise programme. Remember – begin slowly and build up gradually.

Name

Signature

Trainer name

Trainer Signature

Date

Physical Activity Readiness Questionnaire (PAR-Q)