Thankyou for submitting your PARQ form, We will be in touch if we need to discuss your submission.

Name : [field id=”name”]
Surname : [field id=”field_cfc8491″]
Contact Phone Number : [field id=”field_86113ad”]
Email : [field id=”email”]
Emergency Contact Name : [field id=”field_722a40b”]
Emergency Contact Phone Number : [field id=”field_88ab3ca”]


PARQ – General Health Questionnaire

Has your doctor ever said that you have a heart condition or high blood pressure? : [field id=”field_8eab4d9″]
Do you feel pain in your chest at rest, during your daily activities of living OR when you do physical activity? : [field id=”field_6e13b7b”]
Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? : [field id=”field_033ac63″]
Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure) : [field id=”field_4b54d13″]
Realted – Other chronic medical conditions List conditions here : [field id=”field_5836426″]

Are you currently taking prescribed medications for chronic medical conditions? : [field id=”field_0fd1273″]
Additional – List prescribed medications for chronic medical conditions : [field id=”field_b2c3934″]
Do you currently have (or have had within the past 12 months) a bone, joint, of soft tissue (muscles, ligament or tendon) problem that could be made worse by becoming more physically active? : [field id=”field_fbd7c83″]
Additional – problem that could be made worse by becoming more physically active : [field id=”field_52a5de7″]
Has your doctor ever said that you should only do medically supervised physical activity? : [field id=”field_5facf3e”]

Have you answered yes to any of the above : [field id=”field_6d551b3″]


Follow up Questionnaire

1 – Do you have Bone/Joint conditions arthritis, Osteoporosis or back problems? : [field id=”field_5f84dd5″]
Additional – Do you have difficulty controlling your condition with medication? : [field id=”field_ea66fd8″]
Additional – Do you have any joint problems causing pain, recent fracture or fractures caused by osteoporosis or cancer, displaced vertebra and/or spondyloysis/pars defect : [field id=”field_0b77138″]
Additional – Have you had steroid injections or taken steroid tablets regularly for more than 3 months? : [field id=”field_c7648d4″]


2 – Do you have a cancer diagnosis or recovering from treatment? : [field id=”field_99eba2a”]
Additional – Text – Does your cancer diagnosis include any of the following types: lung/broncholgenic, multiple myeloma (cancer of plasma cells), head or neck? : [field id=”field_0e651ca”]
Additional – Are you currently receiving cancer treatment (chemotherapy or radiotherapy? : [field id=”field_d4d8755″]


3 – Have you been diagnosed with a heart or cardiovascular condition? (including coronary artery disease, heart failure of abnormality of heart rhythm) : [field id=”field_0280346″]
Additional – Do you have difficulty controlling your condition with medications? : [field id=”field_2a52169″]
Additional – Do you have an irregular heart beat that requires medical management? (eg arterial fibrillation, premature ventricular contraction) : [field id=”field_bb5f66c”]
Additional – Do you have chronic heart failure? : [field id=”field_c1cdc0e”]
Additional – Do you have coronary artery (cardiovascular) disease and have not participated in regular physical activity in the last 2 months? : [field id=”field_c1cdc0d”]


4 – Have you been diagnosed with high blood pressure? : [field id=”field_5ebb2c2″]
Additional – Do you have difficulty controlling your condition with medication? : [field id=”field_c385ee8″]
Additional – Do you have a resting blood pressure equal to or greater than 160/90 mmHg with or without medication? : [field id=”field_48375f2″]


5 – Do you have any metabolic conditions? ((including diabetes) : [field id=”field_ecbc647″]
Additional – Do you have any difficulty controlling your blood sugar levels with foods or medications? : [field id=”field_edf4bdd”]
Additional – Do you suffer from signs and symptoms of low blood sugar (hypoglycaemia) following exercise and/or during activities of daily living? : [field id=”field_bca723c”]
Additional – Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or complications affecting your eye, kidneys or the sensation in your toes and feet? : [field id=”field_e736d2b”]
Additional – Do you have other metabolic conditions (such as current pregnancy relations diabetes, chronic kidney disease or liver problems? : [field id=”field_9b59a6f”]


6 – Do you have any mental health problems or learning difficulties (includes Alzheimer’s, dementia, depression, anxiety disorder, psychotic disorder, Intellectual Disability, down syndrome? : [field id=”field_52748f3″]
Additional – Do you have difficult controlling your condition with medication : [field id=”field_19eefae”]


7 – Do you have respiratory disease including (Chronic obstructive pulmonary disease, Asthma, pulmonary high blood pressure)? : [field id=”field_435d62b”]
Additional – Do you have difficulty controlling your condition with mediations? : [field id=”field_b22e2b5″]
Additional – Has your doctor ever said your blood oxygen level is low at rest of during exercise and/or that you require supplemental oxygen therapy? : [field id=”field_d028a14″]
Additional – If asthmatic do you currently have symptoms of chest tightness, wheezing, laboured breathing, consistent cough (more than 2 days week), or have you used your rescues medication more than twice in the last week? : [field id=”field_9019220″]
Additional – Has your Dr ever said you have high blood pressure in the blood vessels of your lungs? : [field id=”field_1faf3e8″]


8 – Do you have a spinal cord injury? : [field id=”field_dc7ff9a”]
Additional – Do you have difficulty controlling your condition with medication? : [field id=”field_9e7f6b1″]
Additional – Do you commonly exhibit low resting blood pressure significant enough to cause dizziness, light-headedness, and or fainting? : [field id=”field_af3c04c”]
Additional – Has your Dr indicated that you exhibit sudden bouts of high blood pressure (Autonomic Dysreflexia)? : [field id=”field_a96370a”]


9 – Have you had a stroke? Includes Transient Ischemic Attack (TIA) or Cerebrovascular Event? : [field id=”field_083de5e”]
Additional – Do you have difficulty controlling your condition with medication? : [field id=”field_d37730e”]
Additional – Do you have any impairment in walking or mobility? : [field id=”field_a96370a”]
Additional – Have you experienced a stroke or impairment in nerves or muscles in the past 6 months? : [field id=”field_502b4ab”]


10 – Do you have any other medical condition not listed above or do you have two or more of the medical conditions? : [field id=”field_502b4gh”]
Additional – Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)? : [field id=”field_82c4012″]
Additional – Do you currently live with 2 or more medical conditions? : [field id=”field_0832077″]
Sub Additional – Please list currently live with 2 or more medical conditions : [field id=”field_2460de8″]