PAR Q Form

Physical Activity Readiness Questionnaire – PAR-Q

Name

First Last

Date Of Birth*

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Email*

Phone*

PLEASE READ CAREFULLY

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the six questions below. 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 start. Please read the questions carefully and answer each one honestly by checking YES or NO

Q1*

Has your doctor ever said that you have a heart condition or that you should only do physical activity recommended by a doctor?

YES
NO

Q2*

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

YES
NO

Q3*

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

YES
NO

Q4*

Do you have a bone or joint problem that could be made worse by physical activity?

YES
NO

Q5*

Is your doctor currently prescribing drugs for your blood pressure or a heart condition?

YES
NO

Q6*

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

YES
NO

If you answered YES to one or more questions

Talk with your doctor BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES to. You may be able to do any activity you want – as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow their advice.

If you answered NO

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can Start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go. Take part in a fitness appraisal. This is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active.

Delay becoming more active: •

If you are not feeling well because of a temporary illness such as cold or a fever, wait until you feel better; or if you are or may be pregnant, talk to your doctor before you start becoming more active. Please note: If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.

Informed Use of the PAR-Q:

Intelligent Fitness and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity. I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction

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PARQ Form