Jeremy Johnston Personal Training

Client Forms: PAR-Q

The PAR-Q is designed to help you help yourself. Many benefits are associated with regular exercise and completion of the PAR-Q form is a sensible first step to take if you are planning to increase the amount of physical activity in your life.

The PAR-Q has been designed to identify the small number of people for whom physical activity might be inappropriate or for those who should seek medical advice concerning the type of activity most suitable for them. Common sense is the best guide for answering the questions.

Name

First Name

Last Name

Email Address

Contact Number

Date of Birth

YYYY

Emergency Contact

First Name

Last Name

Emergency Contact Number

Question 1

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

Question 2

Do you feel pain in your chest when you do phsical activity?

Question 3

In the past month, have you had any chest pain when you were not doing physical activity?

Question 4

Do you lose balance because of dizziness or do you ever lose consciousness?

Question 5

Do you have a bone or joint problem (ie back, knee or hip) that could be made worse by a change in physical activity?

Question 6

Is your doctor currently prescribing you medication which should affect participation in physical activity?

Question 7

Do you know any other reason why you should not do physical activity?