If you are between the ages of 15 and 69, this PAR-Q form 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 clicking either 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
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.
Today's Date: 10 June 2023
Please sign disclaimer form below (use mouse or finger) and click Send
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.
Your name
Your signature