Human Motion Performance – PAR-Q Medical & Training Questionnaire At Human Motion Performance, your safety and wellbeing come first. The purpose of this questionnaire is to identify any health considerations that might affect your participation in physical activity. Please read each question carefully and answer truthfully. If you’re over 69 or have any medical concerns, consult your doctor before making significant changes to your exercise routine. Personal Information Name * First Name Last Name Date of birth * MM DD YYYY Email * Phone * Country (###) ### #### Medical Questions If the answer is YES, please click inside the circle and answer any additional questions that may pop up underneath. If the answer is NO, please leave black and move onto the following questions Has your doctor ever said 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 doing physical activity? Do you lose 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 heart condition? Do you know of any other reason why you should not engage in physical activity? Do you have or have you ever had any diagnosed medical conditions? If yes, please list: Have you suffered any injuries? If yes, please explain: Have you ever had physical therapy? If yes, please explain: Are you currently on any medications? If yes, please list them: Are you currently in pain? If yes, on a scale of 1–10, how would you rate it today? Have you had any recent surgery? If yes, please explain: What is your budget? How did you hear about us? Option 1 Option 2 Message * Thank you!
