PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

Physical Activity Readiness Questionnaire

	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 you perform physical activity?
In the past month, have you had chest pain when you were not performing any physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
Do you know of any other reason why you should not engage in physical activity?

Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc)?

YesNo
If yes, please explain.
Have you ever had any surgeries?

YesNo
If yes, please explain.
Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol, or diabetes?

YesNo
If yes, please explain.
Are you currently taking any medication?

YesNo
If yes, please list.
If you have answered "Yes" to one or more of the above questions, please consult your physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.
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