PAR-Q & Readiness to Exercise Form

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Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
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

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

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

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

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

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

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

YesNo
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.

Yes
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.
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