PAR-Q Form

PAR-Q Form
If you are between the ages of 15 and 69 the PAR-Q will tell you if you should check with your doctor before you significantly change your physical actvity patterns.

If you are over 69 and are not used to being very active, check with your doctor before participation.

Rows	Yes	No
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor ?
Do you feel pain in your chest when performing physical activity?
Have you experienced chest pain when NOT performing physical activity in the last month?
Do you lose your balance because of dizziness or have you lost consciousness recently?
Do you have bone or joint problems such as arthritis which could be aggravated through physical activity?
Is your doctor currently prescribing medications for high blood pressure of heart problems?
Has your doctor ever told you NOT to exercise?
Is there any reason you should NOT participate in physical activity?

If you answered yes to the last question please explain here
If you answered YES:
If you answered yes to one or more questions, have been inactive or are concerned about your health consult a physician before taking a fitness test or substantially increasing your physical activity. You shoudl ask for medical clearance along with information about specific exercise limitations you may have.

In most cases you will be able to do any type of exercise as long as you adhere to some guidelines.
Declaration

Having answered YES to one or more of the above I have sought medical advice and my GP has agreed that I may exercise. Please note that the physical activity clearance is valid for a maximum of 12 months from the date it is completed.
Client Name:
Date:

MonthDayYear
Date
If you answered NO:
If you answered no to all the PAR-Q questions, you can be reasonably sure that you can exercise safely and have low risk of having any medical complications from exercise. It is still important to increase gradually. It is also important to have a fitness assessment prior to exercise to determine where to begin.

PLEASE NOTE: If your health changes so that subsequently you answer YES to any of the above questions please inform myself or Ted (your personal trainers) immediately to adjust your exercise plan accordingly.
When to delay the start of an exercise program:
If you are not feeling well because of a temporary illness such as a cold or a fever, wait until you feel better to begin exercising. If you are or may be pregnant, consult your doctor before becoming more active.
Declaration

I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise and my participation involves a risk of injury.
I am aware that The Awkward Athlete does not diagnose injuries, prescribe medication and only advises on injury care and prevention to enhance the workout or recovery.
Client name:
Date:

MonthDayYear
Date
Should be Empty:

PAR-Q Form

If you answered YES:

Declaration

If you answered NO:

When to delay the start of an exercise program:

Declaration