PHYSICAL ACTIVITY READINESS QUESTIONNAIRE
(PAR-Q)
If you are between the ages of 15 and 69, and planning to become much more physically active than you are now, the PAR-Q will tell you if you should check with your doctor before you start.
Please read the following questions carefully and answer each one honestly.
| YES | NO | |
| 1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? | ||
| 2. Do you feel pain in your chest when you do physical activity? | ||
| 3. In the past month, have you had chest pain when you were not doing physical activity? | ||
| 4. Do you lose your balance because of dizziness or do you ever lose consciousness? | ||
| 5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? | ||
| 6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart conditions? | ||
| 7. Do you know of any other reason why you should not do physical activity? |
If you answered YES to one or more questions, you should talk with your doctor before you start becoming much more physically active.
Assumption of Risk
“I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities which may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death.”
“Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise which is within my capability.”
Informed use of the Health Agreement (PAR-Q)
Vlad Dimov assumes no liability for persons who undertake physical activity.