FAST PAR-Q FORM

FAST HPG PAR-Q Form

Name *

First

Last

Contact Number *

Email *

Age

Weight kg *

Height (cm) *

General Practitioner Contact Number *

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 reasons why you should not engage in physical activity? *

Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc.)? *

If yes, please explain.

Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, hypertension (high blood pressure), high cholesterol or diabetes? *

If yes, please explain.

Are you currently taking any medication? *

If yes, please list.

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