ParQ_Screening

Par Q

Physical Activity Readiness Questionnaire
Private and Confidential

The contents of this form will be private and confidential and stored within GDPR regulation. Your health questionnaire will be discussed with you prior to training commencing to assess suitability for training.
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sex
Phone Number*
Email Address*
Occupation
Do you have any of the following?

if yes to any, please tell us at the end.
Heart Condition?

YesNo
Chest Pains?

YesNo
Low / High Blood Pressure?

YesNo
Dizziness During / After Physical Exercise?

YesNo
Pre / Post Natal?

YesNo
Medication?*

Yes - please state belowNo
Details of medication.
Joint Bone Issues?

YesNo
Describe bone/joint issues.
Currently Injured?

Yes - please describeNo
Please describe injury or previous injury.
Currently Ill?

Yes - please describeNo
Please describe illness.
Mental Health Issues?

YesNo
Please describe.
Do you know any reason you should not exercise or do physical activity?

YesNo
If you answered yes to any of the above questions, talk with your Doctor BEFORE you begin training. Tell the doctor of your intention to exercise and which questions you answered ‘yes’ to. If at any stage your health changes , resulting in a ‘yes’ answer to the above questions please seek guidance from a GP.
If you have answered yes to any questions, please tell us a bit more here.
Goals
Exercise History
Dietary Issues
Is there anything else about your health and well-being that you feel is important to you?
Smoker
Alcohol Intake
Hours Sleep Per Day
Weight (kg)
Height (cm)
Activity Level
Do you give Grassroots Wrestling Scotland permission to be able to use your image for promotional & advertisement purposes?

YesMaybeNo
Date*
Signature*

Par Q

Private and Confidential

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