Physical Activity Readiness Questionnaire (PARQ)

Please complete this form as accurately as possible. The questionnaire identifies the small number of people who may need to seek medical advice prior to starting an exercise programme or class. All information is confidential and stored securely online.

Select NO or YES

Q1. Has a doctor ever said you have a heart condition?

Q2. Have you ever experienced chest pain with exertion or at rest?

Q3. Do you experience severe dizziness, fainting or blackouts?

Q4. Do you have any muscle, bone or joint problems?

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Q5. Are you over 65 years of age and currently unused to exercise or activity?

Q6. Do you currently have high blood pressure?

Q7. Are you currently taking any prescription medication?

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Q8. Are you pregnant or have you given birth in the last 6 months?

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Q9. Have you had surgery in the past 6 months?

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Q10. Do you suffer from asthma or any other breathing conditions?

Q11. Do you have type I or II Diabetes Mellitus?

Q12. Do you smoke or have you quit smoking within the last 6 months?

Q13. Do you have epilepsy?

Q14. Do you suffer from any allergies?

Q15. Is there any other physical condition that would prevent you exercising?

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Q16. How would you describe your current fitness levels?

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