Personal training PAR-Q

Pre-exercise physical readiness questionnaire, with doctor clearance when needed.

Use this template

Physical activity readiness questionnaire

Before you start training, answer honestly. If any answer is "Yes", we may ask for a doctor's clearance — it's for your safety.

Full name

Nombre

Apellido

Date of birth

Phone number

Answer Yes or No

	Yes	No
Has a doctor ever told you that you have a heart condition?
Do you feel chest pain during physical activity?
In the past month, have you had chest pain while at rest?
Do you lose your balance from dizziness, or have you ever lost consciousness?
Do you have a bone or joint problem that could worsen with exercise?
Do you take medication for blood pressure or a heart condition?
Do you know of any other reason you should not do physical activity?

Did you answer "Yes" to any question?

Yes No, all answers were "No"

Tell us more about those answers

Doctor's clearance (if you already have it)

Max 10 MB per file · pdf, jpg, jpeg, png

You can train as soon as your doctor signs off. If you don't have it yet, we'll request it later.

Emergency contact

Contact phone

Signature

Sign here