Physical Activity Readiness Questionnaire (PAR-Q)

Name *
Date of Birth *
Date of Birth
Have You Ever Had: *
Fill out all that are applicable.
If not, simply answer no.
Do you have a family history of your father or other first-degree relative suffering from a heart attack or sudden death before the age of 55? *
Do you smoke, or have you quit smoking within the last year? *
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by your doctor? *
Do you feel pain in your chest when you perform physical activity? *
In the past month, have you had chest pain when you were not involved in physical activity? *
Do you lose your balance because of dizziness, or do you ever lose conciousness? *
Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
If this doesn't apply to you, simply state no.
If you aren't aware of any limitations, simply state no.
If this doesn't apply to you, simply ignore it.