PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

Many benefits are associated with regular exercise and completion of the PAR-Q form is a sensible first step to take if you are planning to increase the amount of physical activity in your life. For most people, physical activity should not pose a problem or risk.

The PAR-Q is designed to identify the small number of people for whom physical activity might be inappropriate or for those who should seek medical advice concerning the type of activity most suitable for them. Common sense and honesty are your best guides for answering these questions

First name

Last name

Birthday

Day

Month

Year

Email

Phone

Address

If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before making a significant change to your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.

Has your doctor ever said 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 exercising?

Yes

No

Do you lose balance due to dizziness or do you ever lose consciousness?

Yes

No

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

No

Are you currently on medication for blood pressure or a heart condition?

Yes

No

Is there any other reason why you should not take part in physical activity?

Yes

No

If YES, please comment:

If you answered YES to one or more questions:

You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

If you answered NO to all of the questions: It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels.

Having answered YES to one of the questions above, I have sought medical advice and my GP has agreed that I may exercise.

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 may involve a risk of injury.

Name

Signature

Signature field is empty.

Date

Day

Month

Year

Note: This PARQ becomes invalid should your condition change

Please visit the website to see our Privacy Notice for more details on why we need the information, what we do with it, how it is stored and how long it is retained