Nasm Physical Activity Readiness Questionnaire & General & Medical Questionnaire Template printable pdf download

Nasm Physical Activity Readiness Questionnaire & General & Medical Questionnaire Template

Data Collection Sheet

NAME:_________________________________________ DATE:_________________

HEIGHT:_________in.

WEIGHT:___________lbs.

AGE:__________

PHYSICIANS NAME:____________________________ PHONE:_____________

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

Questions

Yes

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

only perform physical activity recommended by a doctor?

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

In the past month, have you had chest pain when you were not performing any

physical activity?

Do you lose your 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

your physical activity?

Is your doctor currently prescribing any medication for your blood pressure or

for a heart condition?

Do you know of any other reason why you should not engage in physical

activity?

If you have answered “Yes” to one or more of the above questions, consult your physician before

engaging in physical activity. Tell your physician which questions you answered “Yes” to. After a

medical evaluation, seek advice from your physician on what type of activity is suitable for your

current condition.

Nasm Physical Activity Readiness Questionnaire & General & Medical Questionnaire Template