Physical Activity Readiness Questionnaire (PAR-Q)

Your Name: ___________________ Date: _______________

Your Age: ___________

Please answer the following questions honestly for your safety and health.

1. 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

2. Do you feel pain in your chest when you do physical activity?
   - [ ] Yes
   - [ ] No

3. In the past month, have you had chest pain when you were not doing physical activity?
   - [ ] Yes
   - [ ] No

4. Do you lose your balance because of dizziness, or do you ever lose consciousness?
   - [ ] Yes
   - [ ] No

5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
   - [ ] Yes
   - [ ] No

6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
   - [ ] Yes
   - [ ] No

7. Do you know of any other reason why you should not do physical activity?
   - [ ] Yes
   - [ ] No

If you have answered "Yes" to one or more of the above questions:

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered 'Yes' to.

If you have answered "No" to all the PAR-Q questions:

You can be reasonably sure that you can start becoming more physically active. Start slowly and build up gradually. This is the safest and easiest way to go.

Please note: This questionnaire is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.

Signature: ________________________ Date: _______________