The Physical Activity Readiness Questionnaire for Everyone (2025) Name * First Name Last Name Date of birth * GENERAL HEALTH QUESTIONS These 7 questions will check to ensure you are fit and well enough to participate in Cathy's health and fitness programmes. Please read the 7 questions below carefully and answer each one honestly: check YES or NO. 1 a). Has your doctor ever said that you have a heart condition? * Yes No 1 b). Has your doctor ever said that you have high blood pressure? * Yes No 2). Do you feel pain in your chest at rest, during your daily activities of living OR when you do physical activity? * Yes No 3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? * Please answer NO if your dizziness was associated with over-breathing (including vigorous activities) Yes No 4). Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? * Yes No If YES, please list condition(s) here: 5). Are you currently taking prescribed medications for a chronic medical condition? * Yes No If YES, please list condition(s) and medications here: 6). Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament or tendon) problem that could be made worse by becoming more physically active? * Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active. Yes No If YES, please list conditions here: 7). Has your doctor ever said that you should only do medically supervised physical activity? * Yes No If you answered NO to all the questions above, you are cleared for physical activity. You will now be able to sign the PARTICIPANT DECLARATION at your next meeting with Cathy. If you answered YES to one or more of the questions above, Cathy will contact you to discuss in more detail with you. Thank you!
