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PAR-Q Health Form 

Personal Information
Gender
PARQ Form - Physical Activity Readiness Questionnaire

Please take some time to complete the questions below. Common sense is your best guide when answering these questions.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Yes
No
Do you feel pain in your chest when you do physical activity?
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in physical activity?
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
Yes
No
Do you know of any other reason why you should not do physical activity?
Yes
No

Important Notice

STOP

If you have answered YES to any of the above questions, then you are required to gain consent from your doctor before participating in the group exercise to music session.

Consult

If you answered YES to one or more questions:

  • Consult with your doctor before starting a programme of physical activity.

  • Tell your doctor which questions you answered YES to.

  • Seek medical advice regarding your suitability for exercise.

Delay becoming more active if:

  • You have recently had a temporary illness such as an infection or fever.

  • You are pregnant.

  • Your health changes.

If you answered NO to all questions

Display the remaining guidance exactly as informational text from the document, including the recommendation to consult a qualified exercise professional and the advice regarding people over 45 years old.

Participant Declaration
I hereby consent to taking part in (select all that apply)
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Final Declaration
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