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Physical Activity Readiness Questionnaire (PARQ)

Please complete before attending a fitness class. You only need to do this once unless anything changes between bookings. You should always check with your doctore before significantly changing your physical activity patterns. This form will remain confidential.

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
yes
no
Do you feel pain in your chest when you do physical activity?
yes
no
In the past month, have you had a chest pain when you were not doing physical activity?
yes
no
Do you lose balance because of dizziness or do you ever lose consciousness?
yes
no
Do you have a bone or joint problem ( for example back, knee or hip) that could be made worse by a change in your physical activity?
yes
no
Is your doctor currently prescribing medication for your blood pressure or heart condition?
yes
no
Do you have a pre-existing medical condition?
Do you know of any other reason why you should not take part in physical activity?

If you answered YES to one or more questions: You must consult with your doctor to clarify that it is safe for you to join in with physical activities at this current time and in your current state of health.

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