Physical Activity Readiness Questionnaire (PARQ)

Please fill this form in FULL & as accurately as possible, ensuring it is signed. Personal training services will only be provided if this form is filled in and returned to your Personal Trainer.

Name(Required)

First Last

Email(Required)

Age(Required)

1) Have you ever had any significant medical conditions?(Required)

Yes

No

2) Have you ever had any significant surgical operations?(Required)

Yes

No

3) Have you ever had any significant injury?(Required)

Yes

No

4) Do you, or have you ever, suffered from back pain?(Required)

Yes

No

5) Do you, or have you ever, experienced chest pains?(Required)

Yes

No

6) Is there a history of heart disease in your family?(Required)

Yes

No

7) Have you had your cholesterol levels tested in the last 12 months?(Required)

Yes

No

8) Do you regularly take any drugs or medications?(Required)

Yes

No

9) Do you have any allergies?(Required)

Yes

No

10) Do you suffer from headaches, dizzy or fainting spells, or fits?(Required)

Yes

No

11) Do you get out of breath at rest, at night or after slight exertion?(Required)

Yes

No

12) Do you smoke?(Required)

Yes

No

13) Do you know of any reason why you should not do physical activity?(Required)

Yes

No

If answered yes to any question, please give details below:(Required)

Please sign here:(Required)

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