Physical Activity Readiness Questionnaire (PAR-Q)

Please complete this questionnaire before beginning your personal training program. This helps ensure your safety during physical activity.

First name

Last name

Email address

Date of birth

Day

Month

Year

Health Screening Questions

Please answer the following questions honestly. Your responses will help us design a safe and effective training program for you.

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 that could be made worse by a change in your physical activity?

Yes

No

Is your doctor currently prescribing drugs 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 any question, please provide details

Additional Information

Current activity level

Sedentary (little to no exercise)

Lightly active (light exercise 1-3 days/week)

Moderately active (moderate exercise 3-5 days/week)

Very active (hard exercise 6-7 days/week)

Extremely active (very hard exercise, physical job)

Do you have any injuries or physical limitations we should be aware of?

I certify that I have read, understood and answered honestly the questions above. I understand that if my health changes, I should inform my trainer immediately.

Signature

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Please sign to acknowledge that you have completed this questionnaire truthfully.