PAr-Q Form

The PAR-Q (Physical Activity Readiness Questionnaire) is a short health screening form that helps determine if you are ready to start exercising safely. It identifies any medical conditions or risks that may require consultation with a doctor before beginning a workout program. Please complete this form to ensure your training is safe and suitable for you.

Name *

First

Last

Email *

Date of Birth *

Emergency Contact (Name and Phone Number)

Medical History/Relevant Conditions

1. Do you have a history of heart disease, heart attack, or stroke? *

• Yes
• No

2. Do you experience chest pain or discomfort when engaging in physical activity? *

• Yes
• No

3. Do you experience chest pain or discomfort when not engaging in physical activity? *

• Yes
• No

4. Have you ever lost balance or fainted during exercise? *

• Yes
• No

5. Do you have high blood pressure or a history of hypertension? *

• Yes
• No

activity? smoke fainted

6. Do you have a bone, joint, or muscle condition (e.g., arthritis, osteoporosis) that could be aggravated by physical activity? *

• Yes
• No

7. Are you currently taking any medication(s) for any condition (e.g., blood pressure, heart problems)? *

• Yes
• No

8. Do you have diabetes or any other metabolic disorder? *

• Yes
• No

9. Do you smoke or have you smoked in the past? *

• Yes
• No

10. Are you pregnant or have you recently given birth? *

• Yes
• No

11. Do you experience dizziness, lightheadedness, or shortness of breath during physical activity? *

• Yes
• No

12. Has your doctor ever said you should not engage in physical activity? *

• Yes
• No

I confirm that the above answers are correct and that I will notify ERFUN in case of any changes in my health status. *

• Yes
• No

I confirm that the above answers are accurate to the best of my knowledge. I understand that if my health status changes, I must inform ERFUN before continuing physical activity. By submitting this form, I accept full responsibility for my participation in exercise programs. *

• I Agree
• Deny

Health Concerns & Special Conditions (If Any)

If you have any existing medical conditions, injuries, or other health concerns that could affect your ability to exercise safely, please provide details here. This information helps us tailor your training program to ensure your safety and well-being.

Submit

Thank you for Your time !