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Physical Activity Readiness Questionnaire

PARQ 2026

Primary areas attending;*

Fitness

Sports Participation

Antenatal

Postnatal

Massage Therapy

Consultation or Assessment

Other

First name*

Last name*

Email*

Phone*

Birthday*

Month

Day

Year

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Emergency Contact Details

Name*

Phone*

Address (if different)*

Health Details

Has your doctor ever said you have a heart condition and that you should only do physical exercise recommended by a doctor?*

Yes

No

Do you feel pain in your chest when you do physical activity?*

Yes

No

Do you lose balance because of dizziness or do you ever lose consciousness?*

Yes

No

Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*

Yes

No

Is your doctor currently prescribing medication for your blood pressure or heart condition?*

Yes

No

Are you pregnant or have you given birth in the last 6 months?*

Yes

No

Do you know of any other reason why you should not do physical activity?*

Yes

No

Do yo have any disabilites that affect your day to day lifestyle?*

Yes

No

Have your recently, or do you currently, suffer with any of the following;*

Strain

Sprain

Asthma

Bursitis

Pregnant

Bone Fracture

Eczema

Diabetes

Epilepsy

Cancer

Osteoarthritis

Varicose Veins

Tendonitis

Undiagnosed Lump

Deep Vein Thrombosis

Rheumatoid Arthritis

Dizzyness / Double Vision / Vertigo

Cardiovascular Disease

None of the above

If you have answered Yes for any for any of the health questions, please provide more information here;

YES to one or more questions:

You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

NO to all questions:

It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels.

I declare that the information I’ve provided is accurate & complete

I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.*

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On occasions staff will take photos/videos for the sole purpose of marketing. Should you have any queries on footage being taken, or wish to be withdrawn from inclusion, please speak to our staff directly.

This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the questions. If there are any changes at all in your medical circumstances, please get in touch with us as early as possible.

CONTACT
US

Tel. 07342373427

admin@westryv.com

59 Wigan road

Ormskirk, L39 2AP

WhatsApp Channel

Monday* 06:00 - 12:00 / 15:30 - 21:00

Tuesday 06:00 - 12:00 / 15:30 - 21:00

Wednesday 06:00 - 12:00 / 15:30 - 21:00

Thursday 06:00 - 12:00 / 15:30 - 21:00

Friday 06:00 - 12:00 / 15:30 - 19:00

*Closed Bank Holidays

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Email*

Service enquiring about*

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