Personal Trainer PAR-Q Form (UK)

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

Client Name: __________________________

Date of Birth: ________________________

Emergency Contact: _____________________

Phone Number: _________________________

Please answer the following questions honestly. If you answer YES to any question, consult a medical professional before beginning a training programme.

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

YES / NO

2. Do you feel pain in your chest during physical activity?

YES / NO

3. In the past month, have you had chest pain when not doing physical activity?

YES / NO

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

YES / NO

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

YES / NO

6. Is your doctor currently prescribing medication for blood pressure or a heart condition?

YES / NO

7. Do you know of any other reason why you should not participate in physical activity?

YES / NO

If you answered YES to any question above, you may need medical clearance before participating in exercise.

Client Declaration

I confirm that the information provided above is accurate to the best of my knowledge. I understand that physical exercise involves inherent risks and that it is my responsibility to inform the trainer of any changes to my health.

Client Signature: ______________________

Date: _________________________________