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PAR -Q

Physical Activity Readiness Questionnaire

Contact form

Contact Us

Name

Email

Address

Is there a doctor, physiotherapist, or other health professional who has told you to stop exercising or to only do certain kinds of exercise?

Yes

No

Is there a reason why you should not be physically active?

Yes

No

Have you been diagnosed or treated for a heart condition or chest pain?

Yes

No

Do you ever feel pain in your chest when you are exercising?

Yes

No

Have you ever lost consciousness or felt dizzy or faint while exercising?

Yes

No

Do you have any bone or joint problems that could be made worse by exercise?

Yes

No

Are you taking any medication (other than water pills) for a high blood pressure or heart condition?

Yes

No

Are you pregnant?

Yes

No

YES to one or more questions, please explain further: 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.

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.

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.

By signing below, you acknowledge that you have read and understood the PAR-Q and that you are voluntarily participating in physical activity at Conditioned Fitness Gym Orpington. You agree to assume all risks associated with your participation, including but not limited to the risk of injury. You release Conditioned Fitness Gym Orpington from any and all liability for any injuries you may sustain while participating in their activities.

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Conditioned Fitness Gym Orpington

3 Lombard Street, London

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