Physical Activity Readiness Questionaire (PAR-Q)

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Please read each question and answer honestly. This form is to be used by individuals between the ages of 15 and 69 and helps determine your readiness for physical activity. If you are over the age of 69 please check with your doctor before starting a new exercise program. This form is based on the Physical Activity Readiness Questionnaire. Please email Sue at sue@onthegroundcounselling.ca if you have any questions.

What is your full name? *

Have you had any surgeries in the last 12 months? *

Yes

Are you currently seeing a doctor for a recently diagnosed medical condition? (in the last 12 months) *

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

YES

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

YES

In the past month have you had chest pain when you are not doing physical activity? *

YES

Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

YES

Are you currently on medication for blood pressure regulation or for a heart condition? *

Are you aware of any other reason why you should NOT do physical activity? *

YES

Required

"I have read understood and completed the questionnaire.By selecting 'Agree' it will act as my signature. *

AGREE

What is today's date? *

Submit

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