Health Questionnaire

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  • This form enables me to assess your current physical health and objective so we can plan the best program for you.

    The PAR-Q (Physical Activity Readiness Questionnaire) section below is required to ensure your safety to participate in personal training activities and that you consult your doctor if there are any health concerns that may restrict your participation.

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  • PAR-Q

    Physical Activity Readiness Questionnaire

    Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

    If you are planning to become much more physically active than you are now, start by answering the seven questions in the fields below this section. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 year of age, and you are not used to being very active, check with your doctor.

    Common sense is your best guide when you answer these question. Please read the questions carefully and answer each one honestly: check Yes or NO.

  • Has your doctor ever said you have a heart condition and should restrict your physical activity?
  • Do you feel pain in your chest when you do physical activity?
  • In the past month, have you had any chest pain when you were not doing any physical activity?
  • Do you lose your balance because of dizziness or do you ever lose consciousness?
  • 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?
  • Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
  • Do you know of any other reason why you should not do physical activity?

  • IF YOU ANSWERED:

    YES TO ONE OR MORE QUESTIONS IN THIS SECTION

    Talk with your doctor by phone or in-person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.

    • You may be able to do any activity you want — as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.
    • Find out which community programs are safe and helpful for you.

    NO TO ALL QUESTIONS

    If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

    • start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go.
    • take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active.

  • Please Note:

    If your health changes so that you would then answer yes to any of the PAR-Q questions, let your health or fitness professional. Ask whether you should change your physical activity plan.

    Reasons to Delay Becoming More Active

    • if you are not feeling well because of a temporary illness such as a cold or a fever, wait until you feel better.
    • If you are or may be pregnant, talk to your doctor before you start becoming more active.
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