PAR-Q Disclaimer

Name *

First Name

Last Name

Have you ever had a heart condition or heart surgery? *

Yes

No

Have you ever felt pain in your chest whilst taking part in exercise or at rest? *

Yes

No

Do you ever feel faint, have dizzy spells or suffer from blackouts? *

Yes

No

Do you have a joint problem that could be made worse by exercise? *

Yes

No

Have you ever been diagnosed with high blood pressure? *

Yes

No

Are you pregnant or have you given birth within the past six months? *

Yes

No

Do you suffer from diabetes or epilepsy? *

Yes

No

Are you currently taking any prescription medication? *

Yes

No

Do you know of any other reason why you should not take part in exercise? *

Yes

No

Has a doctor ever said that you should not take part in exercise? *

Yes

No