PAR-Q Physical Activity Readiness Questionnaire (PAR-Q) Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Date: *Height: (in.) *Weight: (lbs.) *Age: *Physicians Name & Phone: *Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? *YesNoDo you feel pain in your chest when you perform physical activity? *YesNoIn the past month, have you had chest pain when you were not performing any physical activity? *YesNoDo you lose your balance because of dizziness or do you ever lose consciousness? *YesNoDo you have a bone or joint problem that could be made worse by a change in your physical activity? *YesNoIs your doctor currently prescribing any medication for your blood pressure or for a heart condition? *YesNoDo you know of any other reason why you should not engage in physical activity? *YesNoIf you have answered "Yes" to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After a medical evaluation, seek advice from your physician on why type of activity is suitable for your current condition. *AgreedWe will provide you with a Doctor's Release form to bring to your medical evaluation if any of your above answers were "Yes". Once your Doctor has cleared you then we can proceed with training. *AgreedCommentSubmit