PAR-Q Questionnaire
Participate Activity Readiness Questionnaire

1. Has your doctor ever said you have a heart condition and that you should only perform 
    activity recommended by a doctor? 

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

3. In the past month, have you had chest pain with activity? 

4. Do you lose balance because of dizziness or do you ever lose consciousness? 

5. Is your doctor currently prescribing drugs for your blood pressure or heart condition? 

6. Do you have a bone or joint problem that could be made worse by a change
    in physical activity?

7. Do you know of any reason why you should not do physical activity?

** If you are over 69 years of age, and you are not used to being very active, check with your doctor.


     Name of MedicationAmountTaken For




Do you have any medications that affect your heart rate? 

If yes, please list. 

If you are uncertain, please consult your doctor.

If you answered YES to one or more questions:  Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and to which questions you answered YES.

If you answered NO to all of the questions: If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.


I have reviewed these questions and answered them to the best of my ability. I understand the materials will be reviewed and I may be asked to see my doctor before participating in Activities.

Birthdate:                                  Age:

Signature:                                                                                        Date:

Witness Signature: 

The Ultimate Judgment of Progress is:
Measurable results in reasonable time.