Physical Activity Readiness Questionnaire (PAR-Q) : Forza Fitness

Physical Activity Readiness Questionnaire

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Health Status

If you are between the ages of 14 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.

Please read each question carefully and answer honestly by indicating YES or NO.
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?	YesNo
Do you feel pain in your chest when you do physical activity?	YesNo
In the past month, have you had a chest pain when you were not doing physical activity?	YesNo
Do you lose balance because of dizziness or do you ever lose consciousness?	YesNo
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?	YesNo
Is your doctor currently prescribing medication for your blood pressure or heart condition?	YesNo
Do you know of any other reason why you should not take part in physical activity?	YesNo

If YES, please comment:

Answered NO:

If you answered NO all questions it is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels.

I have read, understood and accurately completed this questionnaire
I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury

Sign (Please type name/initials):

Date Signed:

If you answered YES:

If you answered YES to one or more questions: You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

Having answered YES to one (or more) of the questions above, I have sought medical advice and my GP has agreed that I may exercise
I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury

Sign (Please type name/initials):

Date Signed:

*NOTES: This PAR-Q becomes INVALID if your conditions change so that you would answer YES to any of the questions.

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Don’t forget you also need to fill out your
WAIVER