PARQ 2024 – Zahar Fitness

1. has your doctor ever said that you have a heart condition or high blood pressure *

Select one *Heart ConditionHigh Blood Pressure

2. do you feel pain in your chest at rest, during your daily activities of living, or when you do physical activity? *

Specify *

3. do you lose balance because of dizziness or have you lost consciousness in the last 12 months? *Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).

4. have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? *

Please list conditions here *

5. are you currently taking prescribed medications for a chronic medical condition? *

please list condition(s) and medications here *

6. do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? *Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.

Please list conditions here *

7. has your doctor ever said that you should only do medically supervised physical activity? *

Name *

Email Address *

Date signed *

I have read and answered all the questions honestly and accurately best to my knowledge. *I agree