Physical Activity Readiness Questionnaire (PAR-Q)
Your safety is our top priority. Please complete this form before participating in any exercise program with The Alice Way.
Empowering your journey to health & wellness with safe, effective movement.
The Alice Way – Personal Training and Fitness
■ info@aliceway.com | ■ www.thealiceway.co.uk | ☎ 07342 824297
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Has your doctor ever said that you have a heart condition OR recommended only medically supervised physical activity?
Do you feel pain in your chest when you perform physical activity?
In the past month, have you had chest pain when not performing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in physical activity?
Is your doctor currently prescribing medication (e.g., for blood pressure or heart condition)?
Do you know of any other reason why you should not take part in physical activity?
I confirm that I have answered this questionnaire truthfully to the best of my knowledge.
I understand that it is my responsibility to consult with my physician if I answered YES to any of the above questions.