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PARQ
Mark
2019-04-05T09:17:10+00:00
Physical Activity Readiness Questionnaire
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Name
*
First
Last
Contact Telephone Number
*
Email
*
Address
Do you have any heart conditions?
*
Yes
No
If yes, please give further details
Do you suffer from any of the following?
*
Diabetes
Asthma
Artritis
Epilepsy
High or Low blood pressure
Osteoporosis
Any injury
None of the above
If yes, please give further details
In the last 6 months, have you had any other the following?
*
An operation
A baby
An illness
None of the above
If yes, please give further details
Are you on any medication that could affect an exercise programme?
*
Yes
No
If yes, please give further details
Do You Smoke?
*
Yes
No
If Yes, how many a day on average do you smoke?
Are you pregnant?
*
Yes
No
Is there anything else that i would need to be aware of before you begin an exercise programme?
*
Yes
No
If yes, please provide further details
Do you currently participate in any form of regular exercise?
*
Yes
No
If Yes, please provide further details
Phone
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