Physical Activity Readiness Questionnaire (Par-Q)

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The Physical Activity Readiness Questionnaire (PAR-Q)

The health benefits of physical activity are clear; more people should engage in physical activity every day of the week. Participating in physical activity is very safe for MOST people. However, some should check with their doctor, another health care practitioner who is licensed to diagnose, or a qualified exercise professional before they startbecoming much more physically active. This questionnaire will tell you whether it is necessary for you to seek further advice before becoming more physically active or engagingin a fitness appraisal.

If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian or care provider may complete this form on your behalf. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly.
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Name
First Name
Last Name
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Has your doctor ever said that you have a heart condition OR high blood pressure?
YESNO
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Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
YESNO
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Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).
YESNO
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Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?
YESNO
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Are you currently taking prescribed medications for a chronic medical condition?
YESNO
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Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.
YESNO
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Has your doctor ever said that you should only do medically supervised physical activity?
YESNO
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If you have answered yes to one or more of the above questions, it is your responsibility to obtain the proper clearance from your doctor before beginning an exercise program.
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I, the undersigned, have read, understood to my full satisfaction and completed the PAR-Q+ online form. I have answered each question truthfully, reflecting my current condition. I acknowledge that this physical activity clearance/recommendation 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 a Trustee (such as my employer, community/fitness centre, health care provider, or other designate) may maintain a copy of this form for their records. In these instances, the Trustee will be required to adhere to local, national, and international guidelines regarding the storage of personal health information ensuring that they maintain the privacy of the information and not misuse or wrongfully disclose such information. The authors, the PAR-Q+ Collaboration, partner organizations, and their agents assume no liability for persons who undertake physical activity. If in doubt after completing the questionnaire, consult your doctor prior to physical activity. Please sign below using your mouse to indicate that you understand and agree to the above.
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