iPhysios

YOU ARE HERE: bookings >>



	Physical Activity Readiness

Already had a session | Medical Appointment Booking | Personal Training Booking

For a personal training session please complete the following:
Physical Activity Readiness Questionnaire (PAR-Q)
Regular physical activity is fun and healthy and has many associated health benefits. Increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.
The completion of the PAR-Q is a sensible first step to take if you are planning to increase the amount of physical exercise in your life. For most people, physical activity should not pose any problems or hazards. The PAR-Q is designed to identify the small number of adults for whom physical activity might be inappropriate or those who should seek medical advice concerning the type of activity most suitable for them.

Full Name *

Email Address *

Contact Number *

Full Address:

Date of Birth: *

Height: *

Weight: *

Physical Activity Readiness Questionaire

1. Do you have a bone or joint problem such as arthritis, which has been aggravated by exercise or might be made worse with exercise?

Yes No

2. To your knowledge, do you have high blood pressure?

Yes No

3. To your knowledge, do you have low blood pressure?

Yes No

4. Do you have Diabetes mellitus or any other metabolic disorder?

Yes No

5. Has your doctor ever said that you have raised cholesterol (serum level above 6.2mmol/L)?

Yes No

6. Do you have or ever suffered a heart condition?

Yes No

7. Have you ever felt pain in your chest when you do physical exercise?

Yes No

8. Is your doctor currently prescribing you drugs or medication?

Yes No

9. Have you ever suffered from shortness of breath at rest or with mild exercise?

Yes No

10. Is there any history of Coronary Heart Disease within your family?

Yes

11. Do you ever feel feint, have spells of dizziness or have ever lost consciousness?

Yes No

12. Do you currently drink more than the average amount of alcohol per week (21units for men and 14 units for women (1 unit = � pint of beer/cider/larger or 1small glass of wine))

Yes No

13. Do you currently smoke?

Yes No

14. Do you NOT currently exercise regularly (at least 3 times per week) and/or work in a job that is physically demanding.

Yes No

15. Are you, or is there any possibility that you might be pregnant?

Yes No

16. Do you know of any other reason why you should not participate in a programme of physical activity?

Yes No

If you have answered YES to any of the above please give details:

Image Verification
	Please enter the text from the image: [Refresh Image] [What's This?]

Powered byEMF Form Builder

If you answered YES to one or more questions:
If you have not already done so, consult with your doctor by telephone or in person before increasing your physical activity and/ or taking a fitness appraisal. Inform your doctor of the questions that you answered 'yes' to on the PAR-Q or present your PAR-Q copy. After medical evaluation, seek advice from your doctor as to your suitability for:
1. Unrestricted physical activity starting off easily and progressing gradually, and �
2. Restricted or supervised activity to meet your specific needs, at least on an initial basis.

If you answered NO to all questions: If you answered the PAR-Q honestly and accurately, you have reasonable assurance of your present suitability for:
1. A graduated exercise programme
2. A fitness appraisal.

| Designed by Trinity Designs