Physical Activity Readiness Questionnaire (PARQ)
Your details
First name:
Surname:
Address:
Postcode:
Tel:
email:
D.O.B. (dd/dd/yyyy):
Medical History
Yes
No
Do you suffer Back / Shoulder / Hip / Knee Pain?
Details:
Do you suffer any joint conditions ie Arthritis?
Details:
Do you suffer High or Low Blood Pressure?
Details:
Have you ever had a Bone Density Count?
Details:
Have you recently given birth?
Details:
Have you recently had any injuries or operations?
Details:
Are you currently taking any medication?
Details:
Any other information you may think is relevent