PAR-Q - Kerrison Fitness

Pre-Activity Readiness Questionnaire (PAR-Q)

Kerrison Fitness accepts no liability for loss, injury or death incurred as a result of exercise. By submitting this form, the client voluntarily assumes full responsibility for their own health and wellbeing.

Name

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

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

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

Has your doctor told you that your blood pressure is too high / low?

Is your doctor currently prescribing medication (e.g. water pills) for your blood pressure or a heart condition?

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

Do you / have you suffered from back problems?

Do you have any respiratory problems or suffer from asthma?

Do you know of any reason why you should not perform physical activity?

Do you smoke?

Are you currently or have you been pregnant in the last six months?

Do you suffer from any medical condition which may be adversely affected by exercise?

If you have answered YES to any of the above, please specify and give detail...

Please provide any additional information here...