Physical Activity Readiness Questionnaire (PAR-Q)

Physical Activity Readiness Questionnaire (PAR-Q)
Do you have a heart condition or cardiovascular disorder?

YesNo
Did the doctor advise you to limit any physical activity?

YesNo
Do you feel any chest pain when you are doing any physical activity?

YesNo
In the past month, did you experience any pain in the chest area when you're not doing anything?

YesNo
Do you usually lose your balance due to being dizzy or even lose your consciousness?

YesNo
Are you experiencing bone or joint problems that worsens if you change your physical activity?

YesNo
Are you currently taking medications for your blood pressure or heart condition?

YesNo
Is there any reason why you should not do physical activities?

YesNo
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 NameLast Name
Gender

MaleFemalePrefer not to mention
Age
Date of Birth

DayMonthYear
Date
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Emergency Contact Person

First NameLast Name
Emergency Contact Person No.

Area CodePhone Number
Should be Empty:

Personal Information