Par Q Form

Physical Activity Readiness Questionnaire

If you are planning to take part in physical activity or an exercise class and you are new to the exercise, start by answering the questions below and make sure you include your name and contact details.

By completing the questionnaire you will be providing information to your instructor that may affect the exercises in the class.

You may be asked to check with your doctor before you start.

All information provided will be treated in the strictest confidence.

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

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

3. Have you ever had chest pain when you were not doing physical activity?*

4. Do you ever feel faint or have spells of dizziness?*

5. Do you have a joint problem that could be made worse by exercise?*

6. Have you ever been told that you have high blood pressure?*

7. Are you currently taking any medication of which the instructor should be made aware?*

8. Are you pregnant or have you had a baby in the last 6 months?*

11. What are your motives for exercising?

How did you find out about Farnham Pilates?

Please select your motivation for doing Pilates

I HAVE UNDERSTOOD AND COMPLETED THIS QUESTIONNAIRE. ALL QUESTIONS WERE ANSWERED TO MY FULL SATISFACTION.*

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