PAR-Q Form

Birthday

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 performing physical activity?*

Have you experienced chest pain when NOT performing physical activity in the last month?*

Do you lose your balance because of dizziness or have you lost consciousness recently?*

Do you have any bone or joint problems such as arthritis, which could be aggravated through physical activity?*

Is your doctor currently prescribing you medications for high blood pressure or a heart condition?*

Have you had an operation in the last 12 months?*

Is there any reason why you should NOT participate in physical activity?*