PAR-Q

Client Readiness for Exercise

Physical Activity Readiness Questionnaire (PAR-Q)

Name *

First

Last

Email *

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

Yes
No

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

Yes
No

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

Yes
No

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

Yes
No

Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

Yes
No

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

Yes
No

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

Yes
No

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 medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition *

I will seek medical guidance.
N/A

What is your occupation? *

What is your occupation?

Does your occupation require extended periods of sitting? If YES, please explain.) *

Does your occupation require extended periods of sitting? If YES, please explain.)

Does your occupation require you to wear shoes with a heel (e.g., dress shoes)? *

Yes
No

Do you partake in any recreational physical activities (golf, skiing, etc.)? (If YES, please explain.) *

Do you partake in any recreational physical activities (golf, skiing, etc.)? (If YES, please explain.)

Have you ever had any injuries or chronic pain? (If YES, please explain.) *

Have you ever had any injuries or chronic pain? (If YES, please explain.)

Has a medical doctor diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes? (If YES, please explain.) *

Has a medical doctor diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes? (If YES, please explain.)

Are you currently taking any medication? (If YES, please explain.) *

Are you currently taking any medication? (If YES, please explain.)

Additional Information

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