Physical Activity Readiness Questionnaire (PAR-Q)

(A Questionnaire for People Aged 15 to 69)

Basic Information

First Name

Last Name

Address

Street Address

City

State

Country

Postal code

Email *

Phone *

Introduction

Regular physical activity is healthy, and most people can safely be more active. However, some individuals should consult a doctor before significantly increasing their activity levels.
If you are between the ages of 15 and 69, this questionnaire will help you determine if you should consult a doctor before becoming more physically active. If you are over 69 and not used to being very active, you should consult your doctor.

Please answer the following questions carefully and honestly.

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 (for example, back, knee or hip) 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 answered YES to one or more questions:

Talk to your doctor 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.
You may be able to do any activity you want – as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.
Find out which community programs are safe and helpful for you.

If you answered NO to all questions:

You can be reasonably sure that you can start becoming much more physically active - begin slowly and build up gradually. This is the safest and easiest way to go.
You can take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively.

Important Notes

Delay becoming much more active if you are not feeling well due to a temporary illness, such as a cold or fever, or if you are or may be pregnant, and talk to your doctor first.
If your health changes so that you then answer YES to any of the questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.
This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the seven questions.

Sign and submit your questionnaire

Your Name *

Signature *

Clear

Date signed *

Signature of Parent or Guardian

Clear

For participants under the age of majority

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Let's Verify You Are Human

Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the seven questions.

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