Enquiry Form - FITISM Wilmslow

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Fitism Ltd - FITISM PAR-Q

Physical Readiness Questionnaire - updated November 2025

Do you feel pain in your chest when you do physical activity?

Yes

Do you have chest pain when you are not doing physical activity?

Yes

Do you suffer from high or low blood pressure?

Yes

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

Yes

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?

Yes

Are you currently being prescribed medication or have you recently finished a course of medication? (if yes please make sure you list ALL below)

Yes

Do you have any allergies? (if yes please give details below)

Yes

Are you diabetic?

Yes

Do you suffer from asthma or any respiratory disorder?

Yes

Are you currently pregnant or recently given birth?

Yes

Do you know of any other reason why you should not take part in physical activity?

Yes

If you answered yes to any of the above please give as much detail as you can below

If you answered yes to any of the above questions you should consult with your doctor (if not already done so) to clarify that it is safe for you to become physically active at this current time and in your current state of health. By submitting this form you confirm that you have read, understood and accurately completed this questionnaire. You confirm that you are voluntarily engaging in an acceptable level of exercise, consulted your doctors advice and you fully understand that your participation involves a risk of injury.