Fresh Fitness PAR-Q Physical Activity Readiness Questionnaire

Being active is important for everyone and it needs to be safe and enjoyable. This
questionnaire lets the fitness professional know that you are fit and healthy to participate
in exercise.
Please answer the questions below honestly to assess your status for exercise.
Please tick if the answer is YES or put a cross if the answer is NO

1.
2.
3.
4.
5.
6.
7.

Have you ever suffered from a heart condition?

Do you feel any pain in your chest when exercising?
In the past month have you had chest pain when not exercising?
Do you suffer from dizziness?
Do you suffer from any bone or joint problems?
Do you have high blood pressure?
Is there any other reason why you should not do physical activity?

If you have answered YES to any of the above, you will need to speak to your doctor
before doing any exercise. If you have had to consult your doctor and are fine to exercise
please make sure your instructor is aware of this. You can complete the form as normal.
If you have answered NO to all of the questions, you are fine to exercise. If you have not
exercised for a long period of time make sure to start slowly and build up your exercise
regime over time.
If your health changes at any time please make your fitness or health professional aware
to see whether your fitness regime needs to change.
This questionnaire is a tool to help safeguard people who exercise. It is your responsibility
(or an adults responsibility if the participant is under 16 years of age) to read it carefully
and answer the questions truthfully.
I have read, understood and completed the questionnaire. I have answered all the
questions honestly to my full satisfaction.
Name:

Signature:

Adults signature (only applicable if the form is for someone under 16) ..
Relationship to child:..
Date

Contact number:.

Please bring this form with you to your next Fresh Fitness exercise class
Fresh Fitness - Ursula McKay 07854 502412 / 028 97532234