PAR-Q CONSENT FORM

A questionnaire for people aged 15-69 
 
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. 
If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor. 
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO. 

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
In the past month, have you had chest pain when you were not doing physical activity? Or had chest pain when doing physical activity?
Do you often feel faint, have spells of severe dizziness or have lost consciousness?
Have you ever suffered from unusual shortness of breath at rest or with mild exertion
Has the doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or that may be made worse by exercise
Do you have either high or low blood pressure. If yes, which type?
Are you currently on any prescribed medicines that may affect your ability to exercise
Are you pregnant or have you had a baby in the last 6 months?
Do you know of any other reason that would affect your ability to participate in physical activity?

If you answered YES to one or more questions: 
 
Talk to your doctor either in person or by phone before you start becoming more physically active and/or taking a fitness appraisal.  Tell your doctor what questions you answered yes to on this form. 
 
You may still be able to do any activity you want as long as you start slowly and build up gradually or it may be that you need to restrict your activities to those which are safe for you. 

© 2019 by THE EXPLORE MORE MUM

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