PHYSICAL ACTIVITY READINESS QUESTIONNAIRE If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor. Common sense is your best guide when answering these questions. Please read carefully and answer each one honestly: Select YES or NO. Name * First Name Last Name Date of Birth * MM DD YYYY Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? * Yes No Do you feel pain in your chest when performing physical activity? * Yes No Have you experienced chest pain when NOT performing physical activity in the last month? * Yes No Do you lose your balance because of dizziness or have you lost consciousness recently? * Yes No Do you have any bone or joint problems such as arthritis, which could be aggravated through physical activity? * Yes No Is your doctor currently prescribing you medications for high blood pressure or a heart condition? * Yes No Have you had an operation in the last 12 months? * Yes No Is there any reason why you should NOT participate in physical activity? * Yes No IF answered YES, please state the reason below: IF YOU ANSWERED NO: If you answered no to all the PAR-Q questions, you can be reasonably sure that you can exercise safely and have low risk of having any medical complications from exercise. It is still important to start slowing and increase gradually. It may also be helpful to have a fitness assessment with a fitness instructor or personal trainer in order to determine where to begin. PLEASE NOTE: If your health changes so that subsequently you answer YES to any of the above questions, inform your fitness or health professional immediately. Ask whether you should change your physical activity or exercise plan. DECLARATION By clicking below and signing it with my name, surname and date I acknowledge that I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury. First Name Last Name Date MM DD YYYY IF YOU ANSWERED YES: If you answered yes to one or more questions, are older than age 40 and have been inactive or are concerned about your health, consult a physician before taking a fitness test or substantially increasing your physical activity. You should ask for a medical clearance along with information about specific exercise limitations you may have. In most cases, you will still be able to do any type of activity you want as long as you adhere to some guidelines. When to delay the start of an exercise program: If you are not feeling well because of a temporary illness, such as a cold or a fever, wait until you feel better to begin exercising. If you are or may be pregnant, talk with your doctor before you start becoming more active. DECLARATION By clicking below and signing it with my name, surname and date I acknowledge that I have read, understood and accurately completed this questionnaire. Having answered YES to one of the above, I have sought medical advice and my GP has agreed that I may exercise. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury. PLEASE NOTE: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the questions above. First Name Last Name Date MM DD YYYY Thank you for completing part 1 of 2!Next, could you please read, sign and date the Informed Consent Form in the link below:Client Consultation (Part 2 of 2)
