Physical Activity Readiness Questionnaire (PAR-Q)
Please answer the following questions to determine your readiness for physical activity
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
-
Phone Number
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
*
Yes
No
Do you feel pain in your chest when you do physical activity?
*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
*
Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
*
Yes
No
Do you know of any other reason why you should not do physical activity?
*
Yes
No
If you answered YES to any of the above, please provide details:
Submit
Should be Empty: