Health questionnaire

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If you are between the ages of 15 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.

Please read each question carefully and answer honestly by indicating YES or NO

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
NoYes

2. Do you feel pain in your chest when you do physical activity?
NoYes

3. In the past month, have you had chest pain when you were not doing physical activity?
NoYes

4. Do you lose your balance because of dizziness or do you ever lose consciousness?
NoYes

5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
NoYes

6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
NoYes

7. Do you know of any other reason why you should not do physical activity?
NoYes

If you answered YES to one or more questions 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.

Otherwise 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.

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Having answered YES to one of the questions above, I have sought medical advice and my GP has agreed that I may exercise.

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