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PAR-Q
Date of Birth
Has your doctor ever said you have a heart condition and that you should only perform physical activity recommended by a doctor?
Yes
No
Do you feel pain in your chest when you perform physical activity?
Yes
No
In the past month, have you had chest pain when you were not performing physical activity?
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
Yes
No
Do you have a bone or joint, or structural problem that could be made worse by a change in your physical activity?
Yes
No
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
Yes
No
Do you know of any other reason why you should not engage in physical activity?
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Questionnaire
What is your occupation, and does it require long periods of sitting / repetitive movements?
Identify/describe the root causes of the stress in your life - and how you de-stress:
What recreational activities do you enjoy, and what kinds of physical activities do you enjoy?
Describe your list of limitations i.e. activities you do NOT enjoy, any orthopedic injuries or medical conditions that limit you in your daily life and activities:
What medications and/or supplements are you taking?
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