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PAR-Q and medical history

For most people physical activity should not pose any problem or hazard. The Physical Assessment Risk Questionnaire (PAR-Q) has been designed to identify the small number of adults who should have medical advice before embarking on an exercise program.

Please read carefully and indicate yes or no to the following questions.

Has your doctor ever said you have heart trouble?*

Yes

Do you frequently have pains in your heart and chest?*

Yes

Do you often feel faint or have spells of severe dizziness?*

Yes

Has a doctor ever said your blood pressure was too high?*

Yes

Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise, or might be made worse with exercise?*

Yes

Are you over age 65 and not accustomed to vigorous exercise?*

Yes

Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*

Yes

If you answered YES to one or more questions you will need to consult with your GP before starting the exercise programme administered by Reach Your Peak or Peak Endurance. If you answered NO to all questions and answered PAR-Q accurately, you have reasonable assurance of your present suitability for run group.

I fully understand the risk inherent in a training program and accept full responsibility for personal bodily injury, death, or property losses that may occur as a result of my being a part of this program or engaging in training sessions with Reach Your Peak or Peak Endurance.

Date*

MM slash DD slash YYYY

Emergency Contact Name*

Emergency Contact Phone/Cell*

Signature*

Please list any past or current injuries/medical concerns that may/will affect your training:

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PAR-Q and medical history

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