Physical Activity Readiness Questionnaire

The PAR-Q Form is a health screening document designed for individuals about to take part in physical activity. The questionnaire will identify health issues and recent injuries, illness, ailments and cardiovascular conditions that require my attention before taking part in natural movement training. 

It’s a quick and effective way of screening people about to participate in physical activity of any kind to ensure you are safely able to take part without risk to yourself. 

All information is treated in strict confidence and if you have any problems please contact me.

Billy


Date of Birth:
Date of Birth:
PAR-Q Questionnaire
Has your doctor ever said that you have bone or joint problems, such as arthritis that has been aggravated by exercise or might be made worse with exercise? *
Do you have high blood pressure? *
Do you have low blood pressure? *
Do you have Diabetes Mellitus or any other metabolic disease? *
Has your doctor ever said you have raised cholesterol (above 6.2mmol/L )? *
Has your doctor ever said you have a heart condition and should only do physical activity recommended by them? *
Do you have any muscle, joint or back disorders that could be aggravated by physical exercise? *
Do you have any conditions that will prevent you performing exercises including high impact moves, running, jumping, pressing, lifting and an elevated heart rate? *
Have you ever felt pain in your chest when you do physical exercise? *
Is your doctor currently prescribing you drugs or medication? *
Have you ever suffered unusual shortness of breath at rest or with mild exertion? *
Is there any history of coronary heart disease within your family? *
Do you often feel faint, have spells of severe dizziness or have lost consciousness? *
Do you currently drink more than the average amount of alcohol per week (21 units for men and 14 units for women)? *
Do you currently smoke? *
Do you currently exercise on a regular basis (at least 3 times per week) and / or work a job that is physically demanding? *
Have you had root canal treatment? *
Are you, or is there any possibility you might be pregnant? *
Do you know any other reason you should not participate in a physical activity programme? *
If you answered YES to one or more questions: If you have not recently done so, consult with your doctor before increasing your physical activity. Seek advice from your Doctor for: I. Unrestricted physical activity starting off easily and progressing gradually, and II. Restricted or supervised activity to meet your specific needs, at least on an initial basis
Medical/Liability Waiver *
I declare that the information that I have given is true and correct and I hereby recognise the inherent risks with physical training and assume any such risks. I release Billy Morgan from all liability should anything befall me in the course of these coaching services and recognise that the advice and physical training that he provides is not meant as a substitute for the medical advice of physicians.
Assumption of Risk *
I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities, which may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me.
Declaration of Consent *
I have completed the Par-Q form to the best of my ability. By signing this I agree that all the information above is correct as of today's date and that if there are any changes to my health I will notify Movementum and if I am ever in doubt about something I hereby agree to communicate clearly in asking for help.
Privacy Policy *
We do not share any of your information with any third parties or profit from you personal information and data. Our Privacy Policy is at the bottom of each page.
Please write your name or initials in the box below. By signing this form electronically you are agreeing to the terms and conditions herein.
Date Today: *
Date Today: