PAR-Q Physical activity readiness questionnaire Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Date of Birth *Phone Number *Emergency Conatct (Name and Phone Number) *Do you have or have you ever had any of the following? (select all that apply)Heart DiseaseHigh Blood PressureLow Blood PressureDiabetesAsthma or Respiratory IssuesJoint or Muscle ProblemsOtherIf you selected “Other”, please specify:Are you taking any medication that may affect your ability to exercise? *YesNoHave you had any past injuries or surgeries? *YesNo surgeries? Name If If yes, please provide details:Have you been advised by a doctor not to exercise? *YesNoHow often do you currently exercise?Never1-2 times per week3-4 times per week5+ times per weekWhat types of exercise do you do? (Select all that apply)WalkingRunningWeight TrainingSwimmingCyclingYoga/PilatesOtherRate your current fitness level (1 = Not active, 10 = Very Active):What are your specific fitness goals?Are you currently pregnant or have you given birth in the last 6 months? *YesNoIf Yes, do you have clearance from your doctor to exercise? *YesNoUse Checkboxes to ensure agreement before submissionI confirm that the information provided above is accurate. I understand the risks associated with exercise and agree to participate at my own risk.I consent to my data being stored in compliance with GDPR regulations.Digital Signature I confirm that typing my full name below serves as my digital signature.Full NameDate *Submit
