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Physical Activity Readiness Questionnaire (PAR-Q)

Name *
Phone Number *
Phone Number
Emergency Contact Number *
Emergency Contact Number
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? *
Do you feel pain in your chest when you perform physical activity? *
In the past month, have you had chest pain when you were not performing any physical activity? *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? *
Are you pregnant or have you had a baby in the last six months? *
Do you know of any other reason why you should not engage in physical activity? *
If you have answered “Yes” to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered “Yes” to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you answered "No" honestly to all PAR-Q questions, you can be reasonably sure that you can: A) Start becoming much more physically active. Begin slowly and build up gradually. This is the safest and easiest way to go. B) 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