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LaurynMaeMove PT PAR-Q
If you struggle to complete this form due to any reason, please don't hesitate to contact me on Whatsapp 07967767580
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1.
Has your doctor ever said that you have a heart condition or that you should only do physical activity recommended by a doctor?
(Required.)
Yes
No
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2.
Do you feel pain in your chest during physical activity?
(Required.)
Yes
No
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3.
In the past month, have you had chest pain when you were not doing physical activity?
(Required.)
Yes
No
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4.
Do you lose your balance because of dizziness or have you ever lost consciousness?
(Required.)
Yes
No
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5.
Do you have a bone or joint problem (for example: back, knee, hip, shoulder) that could be made worse by a change in physical activity?
(Required.)
No
Yes, please specify:
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6.
Are you currently taking prescribed medications for blood pressure, heart condition, or any other chronic medical condition?
(Required.)
No
Yes, please specify:
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7.
Do you have a diagnosed physical, cognitive, neurological, or developmental disability that may require exercise modifications or accommodations?
(Required.)
No
Yes, please specify:
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8.
Have you ever been diagnosed with or treated for an eating disorder (such as anorexia, bulimia, binge eating disorder) or are you currently experiencing concerns related to disordered eating that may affect exercise participation?
(Required.)
Yes
No
Other (please specify)
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9.
Are you currently pregnant or have you given birth within the past 6 months?
(Required.)
Yes
No
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10.
Is there any other medical condition, injury, or health concern not mentioned above that may affect your ability to safely participate in exercise?
(Required.)
No
Yes, please specify: