PAR-Q & Readiness to Exercise Form

Name

First NameLast Name

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Date of Birth

Date

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?Type a question

Do you feel pain in your chest when you do physical activity?

In the past month, have you had chest pain when you were not doing physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem (e.g. back, knee, or hip) that could be made worse by physical activity?

Is your doctor currently prescribing drugs (e.g. water pills) for your blood pressure or heart condition?

Do you know of any other reason why you should not do physical activity?

If you answered YES to one or more questions:
You should consult with your doctor before increasing your physical activity. Tell your doctor which questions you answered YES to, and seek advice on what types of exercise are appropriate for you.

If you answered NO to all questions:
You can be reasonably sure that you can start becoming more physically active. Begin slowly and build up gradually, increasing your activity over time.

I have read and understood the above and confirm that I have answered the questions truthfully.

Informed Consent & Waiver

I confirm that the information provided above is accurate to the best of my knowledge. I understand that it is my responsibility to inform my trainer of any medical conditions or changes in my health. I understand that participation in physical activity involves risk and I assume full responsibility for any injuries or health conditions resulting from my participation.

By signing below, I consent to participate in the fitness program and acknowledge that I have read, understood, and agreed to the terms above.

Type a question

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