Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity is fun and healthy, and more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below.

If you are between the ages of 16 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.

Common sense is your best guide when answering these questions. Please read carefully and answer each one honestly: select YES or NO.

Notes: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the 7 questions. The information collected from this questionnaire is for the sole purpose of verifying your ability and physical readiness to participate in physical activity safely. This information will not be shared.

PAR-Q

Given name & Surname

Date of Birth (DD-MM-YYYY)

Email Address

Today's Date (DD-MM-YYYY)

1. Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? 1. Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? Yes No

2. Do you feel pain in your chest when you do physical activity? 2. Do you feel pain in your chest when you do physical activity? Yes No

3. In the past month, have you had a chest pain when you were not doing physical activity? 3. In the past month, have you had a chest pain when you were not doing physical activity? Yes No

4. Do you lose you balance because of dizziness or do you ever lose conciousness? 4. Do you lose you balance because of dizziness or do you ever lose conciousness? Yes No

5. 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? 5. 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

6. Is your doctor currently prescribing medication for your blood pressure or heart condition? 6. Is your doctor currently prescribing medication for your blood pressure or heart condition? Yes No

7. Do you know of any other reason why you should not do physical activity? 7. Do you know of any other reason why you should not do physical activity? Yes No

If you answered Yes to #7, please comment here

8. Are you pregnant or have you had a baby less than six weeks ago? 8. Are you pregnant or have you had a baby less than six weeks ago? Yes No

Having answered YES to one of the above, I have sought medical advice and my GP has agreed that I may exercise. Having answered YES to one of the above, I have sought medical advice and my GP has agreed that I may exercise. Yes No

I have not sought medical advice. I have not sought medical advice. You must 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. I understand and I agree to consult my doctor and I will not particpate in any online live or recorded classes or personal training without consent of my doctor. I will complete this form again when I have consent.

GP has agreed GP has agreed 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 agree I agree 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.

NO to all questions: NO to 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.

Waiver: I take full responsibility for any risks, injuries, damages, unknown or known, which I might incur as a result of participating in live or recorded online classes or personal training sessions or programming. I knowingly, voluntarily and expressly waive any claim I may sustain as a result or participating in live or recorded online classes and personal training sessions and programming. I understand that Coach Katya is a trained Personal Trainer and Nutrition coach and provides habits and behaviour-based nutrition, fitness and wellbeing coaching. I understand that Coach Katya is not a medical practitioner, a physiotherapist, a certified dietician or a nutritional therapist. Waiver: I take full responsibility for any risks, injuries, damages, unknown or known, which I might incur as a result of participating in live or recorded online classes or personal training sessions or programming. I knowingly, voluntarily and expressly waive any claim I may sustain as a result or participating in live or recorded online classes and personal training sessions and programming. I understand that Coach Katya is a trained Personal Trainer and Nutrition coach and provides habits and behaviour-based nutrition, fitness and wellbeing coaching. I understand that Coach Katya is not a medical practitioner, a physiotherapist, a certified dietician or a nutritional therapist. Yes, I agree

11 + 4 =