PAR-Q

PAR-q fORM

DEMOGRAPHIC DATA

* Indicates required field

Name *

First

Last

Email *

QUESTIONS - All questions are required.

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? *

Yes No

Do you feel pain in your chest when you perform physical activity? *

Yes No

In the past month, have you had chest pain when you are not performing any physical activity? *

Yes No

Do you lose your balance because of dizziness or do you ever lose consciousness? *

Yes No

Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

Yes No

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? *

Yes No

Do you know of any other reason why you should not engage in physical activity? *

Yes No

If yes, please explain here: *

I agree to receiving marketing and promotional materials

Submit

* Indicates required field

Your Email *

Submit