Physical Activity Readiness Questionnaire
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 you physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.

It is necessary to complete this medical form before attending the 1st class!

Please let your instructor know if you experience any discomfort and stop at a level which is manageable for you and please inform if anything changes.

Please complete ALL sections of this form. The instructor will discuss with you any areas of concern.
Please read each question carefully and answer honestly by indicating YES or NO.
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Email *
Full name *
Date of birth
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Phone number *
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Clear selection
Do you feel pain in your chest when you do physical activity?
Clear selection
In the past month, have you had a chest pain when you were not doing physical activity?
Clear selection
Do you lose balance because of dizziness or do you ever lose consciousness?
Clear selection
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?
Clear selection
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Clear selection
Are you pregnant or been pregnant in the past 6 months?
Clear selection
Do you know of any other reason why you should not take part in physical activity? If YES, please comment:
Please give any further relevant info:
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. If you answered NO to one or more questions: It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level.  
What are your main reasons for booking a session with Hayley?
By completing and submitting this form you acknowledge that you are participating in this at your own risk and that Hayley MacDonald is not responsible for any injuries that may occur.
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