Physical Activity Readiness Questionnaire (PAR- Q)

Q.1 Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

Yes

No

Q.2 Have you ever felt pain in your chest when you do physical exercise? *

Yes

No

Q.3 In the past month, have you had chest pain when you were not doing physical activity? *

Yes

No

Q.4 Do you often feel faint, have spells of severe dizziness or have lost consciousness? *

Yes

No

Q.5 Have you ever suffered from unusual shortness of breath at rest or with mild exertion? *

Yes

No

Q.6 Has the doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or that may be made worse by exercise? *

Yes

No

Q.7 Do you have either high or low blood pressure. If yes, which type?

Yes - High Blood Pressure

Yes - Low Blood Pressure

No

Q.8 Are you currently on any prescribed medicines that may affect your ability to exercise? *

Yes

No

Q.9 Are you pregnant or have you had a baby in the last 6 months? *

Yes

No

Q.10 Do you know of any other reason that would affect your ability to participate in physical activity? *

Yes

No

Name *

Type name as signature

First Name

Last Name

Date *

MM

DD

YYYY