Physical Activity Readiness Questionnaire (PAR-Q)


This PAR-Q is designed to help you help yourself. Many health benefits are associated with regular exercise, and the completion of this PAR-Q 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 hazard. This PAR-Q has been designed to identify the small number of people for whom physical activity might be inappropriate or those who should take medical advice concerning the type of activity most suitable for them. Common sense is your best guide for answering these few questions...

Please complete all fields marked *


First of all, please provide us with your details...
Name: * Address Line 1: *
Date Of Birth: * Address Line 2:  
Gender: * Address Line 3:  
Phone Number: * Town/City: *
Mobile Number: * County:  
Email Address: * Postcode: *
 
Next, please provide us with a name and telephone number for your emergency contact...
Name: * Number: *
 
Now please complete all of the following questions...
Please read the questions very carefully and be sure to answer each one honestly. Please tick either the YES or NO box for each one. If you answer YES to any of the questions, please give as much detail as possible in the text box below.
Do you have, or have you ever suffered from:
A heart condition YESNO
Chest pains when at rest or when exercising YESNO
Diabetes YESNO
Epilepsy YESNO
A muscle/joint condition or injury YESNO
A neck/back condition or injury YESNO
High/low blood pressure YESNO
Dizziness or loss of consciousness at rest or while exercising YESNO
 
Are you pregnant, or have you recently given birth? YESNO
Have you recently had a major operation? YESNO
Are you currently taking medication which may affect your ability to exercise safely? YESNO
Do you have any other reason which may affect your ability to exercise safely? YESNO
 
If you answered YES to any of the above questions, please give details...
 
If you answered YES to one or more of the above questions, please talk to your GP before commencing a personal training program.
If you answered NO to all of the above questions, you can be reasonably sure that you can start a personal training program.
Please note - if your health changes, please inform your personal trainer.
 
I declare that the information I have given on this form is correct and complete to the best of my knowledge and belief.