What is your goal?*
Do you have any past or present injuries or medical conditions?*
Are you currently feeling stressed or tired or have trouble sleeping?*
Do you have any food allergies or special nutritional requirements?*
Have you exercised before?*
What is your current daily activity level?*
Would you like a Gym or No Gym programme?*
How much time do you have to exercise?*
PRE-ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)
1. Has your Doctor ever said that you have a bone or joint problem, such as arthritis, that
has been aggravated by exercise or might be made worse by exercise?
2. Do have high blood pressure?
3. Do you have low blood pressure?
4. Do you have Diabetes Mellitus or any other metabolic disease?
5. Has your Doctor ever said you have raised cholesterol?
6. Has your Doctor ever said that you have a heart condition?
7. Have you ever felt pain in your chest when you do physical exercise?
8. Is your Doctor currently prescribing you drugs or medication?
9. Are you currently taking any drugs or medication not prescribed by your doctor?
10. Have you ever suffered from unusual shortness of breath at rest or mild exertion?
11. Do you often feel faint, have spells of severe dizziness or have lost consciousness?
12. Is there any history of heart disease in your family?
13. Are you or is there a possibility that you might be pregnant?
14. Do you know of any other reason why you should not take part in physical activity?
If you answered Yes to one or more questions:
If you have not recently done so, consult with your doctor by telephone or in person before increasing your
physical activity and/or taking fitness appraisal. Tell your doctor what questions you answered ‘yes’ to on PAR-Q
or present your PAR-Q copy.
After medical evaluation, seek advise from your doctor as to your suitability for:
1. Unrestricted physical activity starting off easily and progressing gradually.
2. Restricted or supervised activity to meet your specific needs, at least on an initial basis.
If you answered NO to all questions:
If you accurately answered the PAR-Q, you have reasonable assurance of you present suitability for:
1. A graduated exercise programme
2. A fitness appraisal
Assumption of Risk
I hereby state that I have read and understood and answered honestly the questions above.
I also state that I wish to participate in activities that may include aerobic exercise,
resistance exercise and stretching. I realise that my participation in these activities
involves the risk of injury. Furthermore, I hereby confirm that I am voluntarily engaging
in an acceptable level of exercise, which has been recommended to me.