Physical Activity Readiness Questionnaire (PAR-Q)

Full Name*

Date*

Email*

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

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

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

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

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?*

6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*

7. Do you know of any other reason why you should not do physical activity?*

If you have any previous surgical operations and/or ongoing medical conditions, please let us know below.

Custom Coaching Client Form #1