PAR Q FORM (Pre Activity Readiness Questionnaire) with COVID-19 Form
Pre Activity form - All responses and information will not be shared with anyone other than Steven Miller.
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Pre Activity Readiness Questionnaire & Health History Action Required for YES Responses
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 (the client) is healthy and will not be put at risk from taking part in a fitness programme or regular exercise.
Fitness professionals are not medical professionals and cannot commence a fitness programme with a client who has provided positive responses to a PARQ. In this case, the client will be referred to their local GP to ensure they are ready for exercise.

A yes to the first 6 questions on the PARQ form overleaf will normally result in a referral to your GP however a YES response to questions 7 to 13 depending on the circumstances of each question will not normally require GP consent.

The guide below is our policy and we must enforce on all occasions with no exceptions.

Action Required for YES Responses to PAR-Q Questions
Heart problems? Refer to GP
Circulatory problems? Refer to GP
Blood pressure problems? Check blood pressure
If blood pressure is lower than 160/95 mmHg no referral is necessary
If blood pressure is between 140/90 and 160/95 induct on CV only (Advice to see Doctor)
If blood pressure is between 160/95 and 180/100 accept on GP referral only
If blood pressure is 180/100 or higher will not be accepted
Joint, movement problems? Refer to GP
Feel dizzy or imbalanced during exercise? Refer to GP
Currently pregnant or recently given birth? Ask more questions about pregnancy/birth:
If pregnant and after the first three months, no referral is necessary
If pregnant, within the first three months and was exercising regularly before became pregnant, no referral is necessary
If pregnant within the first three months and not already exercising regularly, refer to GP
If had a natural birth less than 6 weeks ago refer to GP
If had c section less than 10 weeks ago refer to GP

Action Required for YES Responses to Health History Questions

Back/spinal pain? Find out limiting factors, i.e. movement and pain. If in doubt refer to GP
Headaches or migraines? Be aware that people who suffer from headaches on a regular basis may develop a headache caused by exercise while exercising.
Have you recently had surgery? Find out how recent surgery was and what it was if very recent refer to GP.
Currently being prescribed medication? Find out more information about the medicine and possible side effects, if in doubt refer to GP
Recently finished a course of medication? Find out about medication that was taken, if in doubt refer to GP
Diabetes? Not a limiting factor but will need to be aware of the condition, encourage them to carry a snack and ideally, they should take their blood sugar level before and after exercise. Best not to exercise if their level is too low or too high immediately before exercising. Ensure the client drinks plenty of water before, during and after exercise. If in doubt, refer to GP.
Asthma or breathing problems? If the inhaler is required, ensure they have it with them and re-schedule induction if they don’t.

What is your name? *
Address *
Telephone contact *
COVID-19 Self Certification. Are you currently required to be self-isolating? *
Medical Questions.

Do you currently or have you ever suffered from any of the following conditions?

1) Heart problems *
2) Circulatory problems? *
3) Blood pressure problems? *
4) Joint, movement problems? *
5) Feel dizzy or imbalance during exercise? *
6) Currently pregnant or recently given birth? *
If yes to any of the above , please provide details.
Health History
Do you currently receive medical care or do any of the following affect you?

7) Back/spinal pain? *
8) Headaches or migraines? *
9) Have you recently had surgery? *
10) Currently being prescribed medication? *
11) Recently finished a course of medication? *
12) Diabetes? *
13) Asthma or breathing problems? *
Is there is any other reason that you believe may prevent you from taking part in any regular activity? *
If yes to any of the above, please provide details.
Declaration
I have answered all question in this form honestly and I am aware that if I have answered yes to any of the questions I will need to consult my GP before commencing an exercise program if I am affected by any of the questions mentioned in this form now or at a later date I agree to inform my personal trainer or instructor on any changes in health or fitness. By pressing submit you have signed the PARQ readiness questionnaire.

A copy of your responses will be emailed to the address you provided.
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