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Physical Activity Readiness Questionnaire

Please complete this form when booking any physical activity with us.

If you have any questions or queries, please contact us, and we will be happy to assist.

Physical Activity Readiness Questionnaire

Please fill out the following health declaration form in order to participate in our activity. 
Being physically active is very safe for most people. Some people however should check with their doctors before they increase their current level of activity. The PAR-Q has been designed to identify the small number of adults for whom physical activity may be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. 
1. Has your doctor ever said that have a heart condition and that you should only do physical activity recommended by a doctor?
2. Has your doctor ever advised you against physical activity?
3. Do you feel pain in your chest when you do physical activity?
4. In the past month have you had chest pain when you were not doing physical activity?
5. Do you lose your balance because of dizziness or do you ever lose consciousness?
6. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
7. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
8. Do you know of any other reason why you should not do physical activity?

If you answered yes to one or more of the questions above are older than age 40 or have been inactive or if you are concerned about your health then please consult a doctor before taking a fitness test or substantially increasing your physical activity.

Please ask for a medical clearance along with information about specific exercise limitations you may have. In most cases you will still be able to do any type of activity you want, as long as you adhere to some guidelines. Please contact us direct to discuss.

Please note: we will not be responsible for any damage or loss of property belonging to you. We will not accept any liability for for personal injury sustained from the use of our premises or facilities.

Thanks for submitting!

Yoga Class


Underbank Cottage, Raikes Road, Thornton-Cleveleys, FY5 5LS

07793 622686

Yoga Class


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