Par-Q

Pre-activity Readiness Questionnaire

First Name *

Last Name *

Enter Email *

Phone Number *

Date Of Birth *

Address *

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

Yes

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

Yes

In the past month, have you had a chest pain when you were not doing physical activity? *

Yes

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

Yes

Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? *

Yes

Is your doctor currently prescribing medication for your blood pressure or heart condition? *

Yes

Do you know of any other reason why you should not take part in physical activity? *

Yes

If YES, please comment

By ticking this box below I confirm 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 risk of injury. *

Yes