• Pilates Class PAR-Q Form

    Answer the health screening questions before your Pilates session.
  • Format: (000) 000-0000.
  • Do you have a heart condition or have you ever been told by a doctor that you should only do physical activity recommended by a doctor?*
  • Do you feel pain in your chest at rest, during daily activities or during exercise?*
  • In the past month, have you had chest pain when you were not doing physical activity?*
  • Do you lose balance because of dizziness, or have you lost consciousness in the last 12 months?*
  • Do you have a bone or joint problem that could be aggravated by exercise?*
  • Is your doctor currently prescribing medication for your blood pressure or heart condition?*
  • Are you pregnant, or have you given birth in the last 6 months?*
  • Do you have any condition that requires special exercise consideration (e.g., diabetes, epilepsy, asthma, recovery from surgery)?*
  • Do you know of any other reason why you should not do physical activity?*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Declaration & Consent

    I confirm that the information provided in this Physical Activity Readiness Questionnaire (PAR-Q) is accurate and complete to the best of my knowledge. I understand that this information will be used by my instructor to plan and adapt sessions appropriately to my individual needs.I understand that Pilates, like any physical activity, carries an inherent risk of injury. I confirm that I am voluntarily participating in these sessions and take full responsibility for consulting my doctor prior to starting, particularly if I have answered "yes" to any of the health screening questions above, or if I have any doubts about my fitness to exercise.I agree to inform my instructor immediately of any pain, discomfort, dizziness, or change in my health or medical condition before, during, or after a session, and understand that I am free to stop an exercise at any time.I understand that my instructor is not medically trained (unless otherwise stated) and that Pilates sessions are not a substitute for medical advice, diagnosis, or treatment. I understand that the information I have provided will be held securely and used only for the purpose of planning safe and effective sessions. By signing below, I confirm that I have read, understood, and agree to the above.
  • Should be Empty: