PAR-Q - Kate Dalebout

Regular physical activity is fun and healthy, and increasingly 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 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

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

Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?

YES NO

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

YES NO

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

YES NO

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

YES NO

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

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

YES NO

Do you know of ANY OTHER REASON why you should not do physical activity?

YES NO

If you answered YES to one or more questions:

Talk to your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.

If you answered NO to all questions:

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

Delay becoming much more active:

Please note:
If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.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 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.

Sign and return a copy of this form to your trainer by submitting this form electronically

NOTE: If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes.

Full Name

Date

Agreement

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Digital Signature Authorization

I understand by submitting this form I am signing it electronically.

Witness Name

SIGNATURE OF PARENT or GUARDIAN (for participants under the age of majority)

Note: 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 seven questions.

Physical Activity Readiness Questionnaire (PAR-Q)

(A Questionnaire for People Aged 15 to 69)