DMF Fitness Studio

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

Welcome to our PAR-Q Form! Please complete all the questions below.

    PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

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

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

    3) Do you lose your balance because of dizziness or do you ever lose consciousness?

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

    5) Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?

    6) Do you know of any other reason why you should not engage in physical activity?

    7) In the past months, have you had chest pain when you were not performing any physical activity?

    If you have answered "Yes" to one or more of the above questions, consult your doctor before engaging in physical activity. Tell your doctor which questions you answered "Yes" to. After a medical evaluation, seek advice from your doctor on what type of activity is suitable for your current condition.

    GENERAL & MEDICAL QUESTIONNAIRE

    8) Do you currently have any injuries that may affect you during physical activity?

    9) Have you ever had any surgeries that may affect physical activity?

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

    11) Are you currently taking any medication?

    DECLARATION

    I wish to embark on any physical activity with DMF Fitness that includes weight training, aerobic conditioning and the equipment provided by DMF Fitness. I hereby confirm that I do not suffer from any form of condition which prevents my participation in any exercise program.

    I hereby release DMF Fitness, its employees and owners from any claims, demands and cause of action arising from my participation in this exercise program. I agree to abide by the conditions of use as stated in this document.

    I fully understand that should I injure myself as a result of exercise participation, that I hereby release DMF Fitness from any liability now or in the future.