Physical Activity Readiness Questionnaire
Please answer all of the questions below
Client Name:
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Client Telephone Number:
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Client Email Address:
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Client Date of Birth:
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Have you ever been advised by a doctor that you have a heart condition and should only do physical activity recommended by a doctor?
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YES
NO
Do you ever feel pain in your chest when you perform physical activity?
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YES
NO
Have you ever had chest pain when you are not doing physical activity?
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YES
NO
Do you ever feel faint or have spells of dizziness?
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YES
NO
Do you have bone or joint problems that could be made worse by exercise?
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YES
NO
Have you ever been told that you have high blood pressure?
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YES
NO
Are you currently taking any medication?
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YES
NO
Are there any other reasons not mentioned why you should not exercise?
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YES
NO
Are you currently or have you been pregnant in the last 6 months?
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YES
NO
If you answered 'YES' to one or more questions: Before you begin any new physical activity program or undergo a fitness assessment, speak with your doctor, either by phone or in person. Share your PAR-Q results with them, including any questions you answered “YES” to. Depending on your health, you may be able to participate in most activities if you start slowly and increase intensity gradually. In some cases, your doctor may recommend limiting your activity to certain types that are safe for you. Discuss the types of activities you wish to do, follow your doctor’s guidance, and ask about community programs that are safe and suitable for your needs.then please describe below: Please Note: If your health changes and you later answer “YES” to any of the questions above, inform your fitness or health professional. Ask whether you need to adjust your physical activity plan.
By signing, I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.
Client Signature:
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Submit
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