Physical Activity Readiness Questionnaire + General & Medical Questionnaire


Please complete ALL Answers Below

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? *
Do you feel pain in your chest when you perform physical activity? *
In the past month, have you had chest pain when you were not performing any physical activity? *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? *
Do you know of any other reason why you should not engage in physical activity? *
If you answered “Yes” to one or more of the above questions did you consult your physician regarding these matters? *
Does your occupation require extended periods of sitting? *
Does your occupation require you to wear shoes with a heel (dress shoes)? *
Does your occupation cause you anxiety (mental stress)? *