Physical Activity Readiness Questionnaire (PAR-Q)

1

Welcome to the Morphoneogenesis LLC Physical Activity Readiness Questionnaire (PAR-Q)! Your health and safety are our top priority, and this form helps us assess your readiness for physical activity within our Medical Exercise Treatment programs. By answering these questions, you’ll provide us with essential information to tailor your exercise treatment plan based on your unique health needs. Whether you're looking to manage a medical condition or optimize your physical well-being, we use this data to ensure safe and effective participation. Please answer honestly, as this will guide us in creating the most beneficial and individualized experience for you.

2

Name* This field is required.

First Name

Last Name

3

Phone Number* This field is required.

Area Code

Phone Number

4

Email* This field is required.

example@example.com

5

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?* This field is required.

Yes

No

6

Do you feel pain in your chest when you do physical activity?* This field is required.

Yes

No

7

In the past month, have you had chest pain when you were not doing physical activity?* This field is required.

Yes

No

8

Do you lose your balance because of dizziness or do you ever lose consciousness?* This field is required.

Yes

No

9

Do you have a bone or joint problem that could be made worse by a change in your physical activity?* This field is required.

Yes

No

10

Is your doctor currently prescribing medication for your blood pressure or heart condition?* This field is required.

Yes

No

11

Do you know of any other reason why you should not do physical activity?* This field is required.

Yes

No

12

If you answered 'Yes' to any of the above questions, please consult with your doctor before engaging in physical activity. Do you understand this recommendation?* This field is required.

Yes

No

13

Are you currently pregnant or have you given birth within the last six months?* This field is required.

Yes

No

14

Please list any other medical conditions or concerns that may affect your ability to engage in physical activity:

15

Describe any current medication you currently use:

16

Emergency Contact Name

First Name

Last Name

17

Emergency Contact Phone Number

Please enter a valid phone number.

18

By submitting this questionnaire, you confirm that the information provided is accurate and complete to the best of your knowledge. Do you agree?* This field is required.

Yes

No

19

Payment* This field is required.

Medical Exercise Treatment
The Medical Exercise Treatment service at Morphoneogenesis provides a specialized approach to health and rehabilitation through three integral components. Starting with a clinical consultation, clients are assessed by healthcare professionals to understand their medical history and current health status. This is followed by medical results interpretation, where complex diagnostic outcomes are explained in clear, understandable terms, ensuring clients fully grasp their health condition. Based on these insights, a clinical exercise prescription is tailored to each client, designed to address specific medical needs and enhance overall wellness.
$100.00 for each month
SUBSCRIBE