Physical Activity Readiness Questionnaire (PAR-Q)

Physical Activity Readiness Questionnaire (PAR-Q)
Please delay exercise if;

·        You are not feeling well because of a temporary illness such as a cold or fever - wait until you feel better

·        If you are or may be pregnant, talk with your doctor before you start becoming more active.

·        Please consult a Doctor if you develop a condition that may be aggravated by exercise
Do you have a heart condition or cardiovascular disorder?*

YesNo
Did the doctor advised you to limit physical activity and only perform the recommended activities by the professional?*

YesNo
Is there any chest pain when your 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 answered YES to any of the above, please provide details:
Personal Information
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Phone Number
Please enter a valid phone number.Format: 00000000000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Person (if required)

First NameLast Name
Emergency Contact Person No.
Please enter a valid phone number.Format: 00000000000.
Height
Weight
What are your fitness goals?
Signature*
Date

MonthDayYear
Date
Should be Empty:

Physical Activity Readiness Questionnaire (PAR-Q)

Personal Information