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Par Q form
Physical Activity Readiness Questionnaire (PAR-Q) Form
Full Name
*
First
DOB
*
MM
DD
YYYY
Address
*
Post Code
*
Email
*
Telephone No
Please read the questions carefully and answer each one honestly
Do you get chest pains either at rest or after exercise?
*
Yes
No
Do you get out of breath at rest or after slight exertion?
Yes
No
Do you often get headaches, dizziness or fainting spells?
*
Yes
No
Has your doctor ever said that you have a heart condition?
*
Yes
No
Do you regularly take drugs or medicines?
*
Yes
No
Do you get pain or have limited movement in any joints?
*
Yes
No
Are you pregnant or given birth in the last 6 months?
*
Yes
No
Are you aware of any medical condition not mentioned above that may affect you ability to exercise?
*
Yes
No
Please Give Details If You Answered To Any Of The Above Give Details Here:
*
If you answered yes to one or more of the above questions, you must consult your doctor for confirmation that it is safe for you to participate in exercise and return a medical authorisation slip signed by your doctor.
Do you have a recognised disability
Yes
No
If yes please give details
*
Emergency Contact Details
Name
*
Number
Signed
*
CONTACT US
Your Name (required)
Your Email (required)
Subject
Your Message
