VISIT THE ARTISAN ST WEBSITE

Physical Activity Readiness Questionnaire (PAR-Q)

Please read carefully and answer the following questions honestly by ticking the appropriate box:	YES	NO
1) Has you doctor ever said 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 a chest pain when you were not doing physical activity?
4) Do you lose balance because of dizziness or do you ever lose consciousness?
5) Do you suffer or have you ever suffered from heart palpitations?
6) Do you have an existing bone or joint problem that could be made worse by a change in your physical activity?
7) Is your doctor currently prescribing medication for your blood pressure or a heart condition? If yes, please explain
8) Are you pregnant or have you given birth within the last 6 weeks?
9) Are you breastfeeding?
10) Are you currently taking any medication? If yes, please explain
11) Do you have any previous or existing injuries, medical conditions or are you aware of any other reason why you should not participate in physical activity? If yes, please explain

If you have answered YES to one or more of the questions you should consult with your Doctor to clarify that it is safe for you to participate in physical activity at this current time.

I have read, understood and accurately completed this questionnaire.

Client's Signature

Reset Signature

Client's Name * Date Of Birth * Date * Address * Phone No. * Email *

Emergency Contact Details

Name * Phone No *