PAR-Q (Physical Activity Readiness) Questionnaire & Informed Consent Form

 

1. Name: *

 

2. Age? *

 

3. Do you have any medical condition and can only perform exercise recommended by a doctor? *

 

4. Do you lose balance because of dizziness or have been unconscious? *

 

5. In the past month, have you had chest pain when you were not performing any physical activity? *

 

6. Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

 

7. Is your doctor currently prescribing any medication for your blood pressure or a heart condition? *

 

8. Do you know of any reason why you should not engage in physical activity? *

 

9. Do you give informed consent to voluntarily taking part in any exercise proscribed by the trainer  *

 

10. Do you agree to the PT Terms and Conditions set? *

Use our survey software to make a survey.
Report Abuse