If you become more physically active, it's important you are fit to do so. Please read the statements below and indicate which apply to you, for none please select NONE

I have a heart condition
I (sometimes) feel pain in my chest whenever I'm physically active.
In the past month I have had chest pains when not undertaking physical activity.
I have recently lost my balance due to dizziness or lost consciousness.
I have a bone or joint problem which could be made worse by physical activity.
I am currently being prescribed medication by my Doctor for blood pressure or a heart condition.
I am aware of other reasons why I should not take part in physical activity in a gym environment.
NONE of the statements above apply to me.

Please confirm your acceptance of the following statements by checking the box next to each statement.

By completing this Health Agreement (PAR-Q) I confirm that I have responded to the above statements accurately. *
If I have highlighted any health concerns detailed above I understand that I am required to discuss my exercise programme within a gym environment with my Doctor or Health Professional and to take advice on activities which are safe to participate in. *
In the event that I have been advised to seek medical clearance prior to undertaking exercise, I agree to contact my doctor and take responsibility for obtaining written permission prior to the commencement of my exercise programme in a gym environment. *
Should any change in my Health or unusual symptoms occur at any point, I will cease participation and inform a Doctor of these symptoms. *
I understand that I must notify you immediately of any changes in my health. *
Assumption of Risk: I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities, which may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me *
I accept that my details will be stored *
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Informed by agreement to this PAR-Q Project Health UK assume no liability for persons who undertake physical activity. Should you be in any doubt after completing this form you agree to consult your doctor prior to undertaking physical activity.

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