Synchronistic PAR-Q

  • Synchronistic Health & Wellbeing

    Physical Activity Readiness Questionnaire (PAR-Q)
  • Has your doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or might be made worse with exercise?*
  • Do you have high blood pressure?*
  • Do you have low blood pressure?*
  • Do you have diabetes mellitus or any other metabolic disease?*
  • Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
  • Has your doctor ever said you have raised cholesterol (serum level above 6.2mmol/L)?*
  • Have you ever felt pain in your chest when you do physical activity?*
  • Is your doctor currently prescribing you drugs or medication?*
  • Have you ever suffered from unusual shortness of breath at rest or with mild exertion?*
  • Is there any history of coronary heart disease in your family?*
  • Do you often feel faint, have spells of sever dizziness or have lost consciousness?*
  • Do you currently drink more than the average amount of alcohol per week (21 units for men and 14 units for women?*
  • Do you currently smoke?*
  • Do you NOT currently exercise on a regular basis (at least 3 times a week) and/or work in a job that is physically demanding?*
  • Are you, or is there any possibility that you might be pregnant?*
  • Do you know of any reason why you should not participate in a program of physical activity?*

  • If you answered 'yes' to one or more questions: 

     

    If you have not recently done so, consult with your doctor by telephone or in person before increasing your physical activity and/or taking a fitness appraisal. Tell your doctor what questions you answered 'yes'' to on the PAR-Q or present your PAR-Q copy. After medical evaluation, seek advice from your doctor as to your suitability for:

    - Unrestricted physical activity starting off easily and progressiong gradually and,

    - Restricted or supervised activity to meet your specific needs, at least on an initial basis

     

    No to all questions:

    If you answered your PAR-Q accurately, you have reasonable assurance of your present suitability to take part in physical gym activity. 

     

    Assumption of risk:

    I hereby state that I have read, understood and answered honestly the questions of the PAR-Q. I also state I wish to participate in activites that may include aerobic exercise, resistance training and stretching. I realise that my participation in these activites involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise. 

     

    Terms & conditions: 

    I hereby state I have read and agree to the terms & conditions stipulated by LLAMAA Pty Ltd. (link:https://www.synchronistic.com.au/membership-terms)

  • Date*
     - -

  • (additional note: I have taken medical advice and my doctor has agreed that I should exercise) 

  • Date
     - -
  • Should be Empty: