Physical Activity Readiness Questionnaire (PAR-Q) Bethany Athletic Club-Personal Training

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What is the PARQ and why do I need to complete it?

The PARQ (Pre Activity Readiness Questionnaire) is an industry-standard for fitness professionals and fitness faculties to use when screening clients for exercise. The reason for doing this is to ensure you are healthy and will not be put at risk from taking part in a fitness program or regular exercise.

Fitness professionals are not medical professionals and cannot commence a fitness program with a client who has provided positive responses to a PARQ. In this case, thee client will be referred to their local doctor to ensure they are ready for exercise.

Email *

Has your doctor ever said that you have a heart condition? *

Yes

Has your doctor ever said that you have high blood pressure?
*

Yes

Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
*

Yes

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).
*

Yes

Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? If Yes, please list conditions.
*

Are you currently taking prescribed medications for a chronic medical condition? If YES, please list conditions and medications.
*

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? If YES, please list conditions.

Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.

Has your doctor ever said that you should only do medically supervised physical activity?

Yes

Clear selection

Are you currently pregnant?

Yes

Does not apply

Clear selection

If you answered NO to all the questions, it is reasonable for you to assume that you are in a suitable physical condition to start a regular graduated exercise program. If you have any concerns about your readiness to begin exercising with regards to your physical health, please contact your doctor. Please inform your personal trainer if at a later date there are changes to your health or medical history.

If you answered YES to any of the questions, you will need to consult your doctor before commencing an exercise program. A member of the Personal Training Team at Bethany Athletic Club will also provide you with supplemental forms to fill out about your health and medical history.

By signing electronically below I affirm that the above statements are true to the best of my knowledge. If you are under 18 years old, your parent/guardian must sign this form as well. I also acknowledge that Bethany Athletic Club may retain a copy of this form for records. In these instances, it will maintain confidentiality complying with applicable law.

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Full Name/ Date/ Contact Telephone Number

Any additional questions/comments/concerns? *

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