Before your first session

Physical Activity Readiness Questionnaire

Please answer each question honestly with Yes or No. Fields marked with an asterisk (*) are required.

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Client Name *

First

Last

Date *

Address

Post code

DOB

Phone

Email *

Next of kin

Emergency contact number

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

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

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

explain. Client code

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

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

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

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

If yes, please explain.

If you answered:

YES to one or more of the questions above you should consult your doctor to gain consent before participating in physical activity.

NO to all the questions above it is considered reasonably safe for you to participate in regular physical activity. It is recommended that you start slowly – 20-30 minutes of low to moderate exercise, 3-5 times per week – and gradually build up from your current ability level.

It is advisable to consult with a qualified fitness professional to help you develop a safe and effective physical activity plan to meet your fitness goals and health needs.

Declaration *

I have read and understood the questions above and any questions I had have been answered to my satisfaction. I understand that I am voluntarily engaging in a level of exercise appropriate for my ability and that my participation involves a risk of injury.

Client signature (typed full name) *

Type your full name here. A drawn signature requires the WPForms Signature Addon.

Client signature date *

NB. Should your condition change from a NO to YES on any question above then this form becomes invalid and should be completed again after consultation with your GP.

You should complete the PAR Q form every 6-12 months.

You should speak to your doctor if there are any changes to your health which would result in answering YES to any of the above questions.

If you are pregnant you should talk to your doctor for approval before becoming more active.

Physical Activity Readiness Questionnaire (PAR Q)

Physical Activity Readiness Questionnaire

If you answered: