FIT - 2021 PAR-Q+

Physical Activity Readiness Questionnaire

The health benefits of regular physical activity are clear; more people should engage in physical activity every day of the week. Participating in physical activity is very safe for MOST people. This questionnaire will tell you whether it is necessary for you to seek further advice from your doctor OR a qualified exercise professional before becoming more physcially active.

1General Health Questions > 2Participant Declaration 1a > 3Follow Up Questions > 4Participant Declaration 1b > 5Seek Further Information
Name Name First Last
Phone Phone - ### - ### ####
Please Enter Your Email Address:
EMERGENCY CONTACT NAME: EMERGENCY CONTACT NAME: First Last
EMERGENCY CONTACT TELEPHONE NUMBER: EMERGENCY CONTACT TELEPHONE NUMBER: - ### - ### ####
General Health Questions

Please respond Yes or No to the following questions:
	Yes	No
Has your doctor ever said that you have a heart condition?	Has your doctor ever said that you have a heart condition?Yes	Has your doctor ever said that you have a heart condition?No
Has your doctor ever said you have high blood pressure?	Has your doctor ever said you have high blood pressure?Yes	Has your doctor ever said you have high blood pressure?No
Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?	Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?Yes	Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?No
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).	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	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).No
Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? PLEASE LIST CONDITION(S) BELOW.	Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? PLEASE LIST CONDITION(S) BELOW.Yes	Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? PLEASE LIST CONDITION(S) BELOW.No
Are you currently taking prescribed medication for a chronic medical condition? PLEASE LIST CONDITION(S) BELOW.	Are you currently taking prescribed medication for a chronic medical condition? PLEASE LIST CONDITION(S) BELOW.Yes	Are you currently taking prescribed medication for a chronic medical condition? PLEASE LIST CONDITION(S) BELOW.No
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? (Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active. PLEASE LIST CONDITION(S) BELOW.	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? (Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active. PLEASE LIST CONDITION(S) BELOW.Yes	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? (Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active. PLEASE LIST CONDITION(S) BELOW.No
Has your doctor ever said that you should only do medically supervised physical activity?	Has your doctor ever said that you should only do medically supervised physical activity?Yes	Has your doctor ever said that you should only do medically supervised physical activity?No

Please list condition(s) here:
Please list condition(s) and medication(s) here:
Please list condition(s) here:

FIT - 2021 PAR-Q+

FIT - 2021 PAR-Q+

General Health Questions