Par-Q Questionnaire Template printable pdf download

Par-Q Questionnaire Template

PAR-Q FORM

Name:_______________________________________

If you are planning to become much more physically active than you are now, start by answering the eight questions below. If you

are above the age of 15, the PAR-Q will tell you if you should check with your doctor before you start. The American College of

Sports Medicine (ACSM) guidelines require that men over the age of 45 and women over the age of 55 complete a “Medical

Authorization Form” BEFORE training.

YES

1. Are you a man over the age of 45 or a woman over the age of 55?

2. Has your doctor ever said that you have a heart condition and that

you should only do physical activity recommended by a doctor?

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

4. In the past month, have you had chest pain when you were not

doing physical activity?

5. Do you lose your balance because of dizziness or do you ever lose

consciousness?

6. Do you have a bone or joint problem that could be made worse by a

change in your physical activity?

7. Is your doctor currently prescribing medication for your blood

pressure or a heart condition?

8. Do you know of any other reason why you should not do

physical activity?

If you answered:

“YES” to one or more questions. You will need to have a Medical Authorization Form completed by your doctor BEFORE

you meet with a trainer or become more physically active.

“NO” to all questions. You can be reasonably sure that you can become more physically active and take part in a fitness

program.

Signature:_________________________________

Date:__________________

Par-Q Questionnaire Template