Physical Activity Readiness Questionaire (Par-Q)

Many health benefits are associated with regular exercise, and the completion of a Par-Q is a sensible first step to take if you are planning to increase the amount of physical activity in your life. For most people, physical activity should not pose any problem or hazard. Par-Q is designed to identify the number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Common sense is the guide in answering these few questions. If you can not find your problem please add it in the box below.

If Yes Please Explain

Please List Any Over The Counter Medication Or Dietary Supplements You Are Taking

Have You Ever Been Treated For, Diagnosed As Having, Or Currently Suffering From Any Of The Following

If Yes Which Type & When

If Yes Which Type

If Yes Which

If Yes Which Type

How Many Hours Do You Sleep A Night

List Any Medication That You Are Taking As Prescribed By Your Doctor

Female Specific Questions

If So When

Please List Any Illness, Hospitalization Or Surgical Procedures Within The Past 3 Years

Please Give The Date Of Your Last Physical Examination & Results (If Any)

HEALTH DATA COLLECTION FORM