Physical Activity Readiness Questionnaire (PAR-Q)

Participating in physical activity is very safe for most people. This questionnaire will tell you whether it’s necessary for you to seek further advice from your doctor or a qualified exercise professional before becoming more physically active. Please answer each question honestly. 

QuestionsYesNo
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have a bone, joint, tendon, or muscle problem (for example back, knee or hip) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Do you know of any other medical reason why you should not take part in physical activity?
If you have answered YES to any of the above questions, please comment on each:







If you answered No to all these questions: It is safe for you to participate in physical activity.

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

Participation Declaration

I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that the gym/studio/fitness center may retain a copy of this form for it’s records. In these instances, it will maintain confidentiality of the same, complying with applicable law.

If you are under 18 years old or require the assent of a care provider, your parent, guardian, or care provider must also sign this form.

Name _____________________

Date ______________________

Signature _______________________

If under 18

Parent or Legal Guardian ___________________

Signature _______________________