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PAR - Q

Please fill out the following form.

Date of birth
Day
Month
Year
Has your doctor ever said that you have a heart condition or recommended only medically supervised activity?
Yes
No
Do you feel pain in your chest when you do physical activity?
Yes
No
In the past month, have you had chest pain when not doing physical activity?
Yes
No
Do you lose your balance because of dizziness, or do you ever lose consciousness?
Yes
No
Do you have any bone or joint problem that could be made worse by physical activity?
Yes
No
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Yes
No
Do you know of any other reason why you should not do physical activity?
Yes
No
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