Silver Lake Par-Q Form

Silver Lake Par-Q Form

This Physical Activity Readiness Questionnaire has been designed to identify the small percentage of adults who should obtain medical clearance before beginning an exercise program.

1. Has your doctor ever said that you have a heart condition and should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
6. Is your doctor currently prescribing drugs for your blood pressure or heart condition?
7. Do you know of any reason why you should not do physical activity?

*If you answered YES to one or more of these questions, please ask for a Medical Clearance Form so that we may send it to your physician.

Included with your membership is a FREE hour with a Personal Trainer. You will be contacted shortly after this form is submitted.