PAR-Q+

The Physical Activity Readiness Questionnaire for Everyone
The health benefts of regular physical activity are clear; more people should engage in physical activity every day of the week. Participating in physical activity is very safe for MOST people. This questionnaire will tell you whether it is necessary for you to seek further advice from your doctor OR a qualifed exercise professional before becoming more physically active.

1General Health Questions > 2Follow-Up Questions > 3Participant Declaration
GENERAL HEALTH QUESTIONS

Please read the 7 questions below carefully and answer each one honestly: check YES or NO.
1) Has your doctor ever said that you have a heart condition OR high blood pressure?

1) Has your doctor ever said that you have a heart condition OR high blood pressure? Yes No
2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?

2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity? Yes No
3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?
Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).

3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?
Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise). Yes No
4) Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?

4) Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? Yes No
PLEASE LIST CONDITION(S) HERE:
5) Are you currently taking prescribed medications for a chronic medical condition?

5) Are you currently taking prescribed medications for a chronic medical condition? Yes No
PLEASE LIST CONDITION(S) HERE:
6) Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically
active?
Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.

6) Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically
active?
Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active. Yes No
PLEASE LIST CONDITION(S) HERE:
7) Has your doctor ever said that you should only do medically supervised physical activity?

7) Has your doctor ever said that you should only do medically supervised physical activity? Yes No
✔ If you answered NO to all of the questions above, you are cleared for physical activity.

Go to Page 4 to sign the PARTICIPANT DECLARATION. You do not need to complete Pages 2 and 3.
X If you answered YES to all of the questions above

COMPLETE PAGES 2 AND 3.
Delay becoming more active if:
- You have a temporary illness such as a cold or fever; it is best to wait until you feel better.
- You are pregnant - talk to your health care practitioner, your physician, a qualifed exercise professional, and/or
  complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active.
- Your health changes - answer the questions on Pages 2 and 3 of this document and/or talk to your doctor or a
  qualifed exercise professional before continuing with any physical activity program.

PAR-Q+

PAR-Q+

GENERAL HEALTH QUESTIONS

GENERAL HEALTH QUESTIONS

✔ If you answered NO to all of the questions above, you are cleared for physical activity.

X If you answered YES to all of the questions above