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WOW PILATES

E: info@wowpilates.net

M: 07960 031313

W: www.wowpilates.net

Physical Activity Readiness - Questionnaire (PAR-Q)

Are you completing this form for yourself or on behalf of someone else?

Single choice
Yourself
Someone else
Client - Date of Birth
Day
Month
Year

Starting a Pilates Programme

If you are between the ages of 15 and 69, this PAR-Q form will tell you if you need to check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being physically active, check with your doctor. 


Please read each of the questions below, answering honestly:

Has your doctor ever said you have a heart condition and you should only do physical activity recommended by your doctor?

Has your doctor ever said you have a heart condition and you should only do physical activity recommended by your doctor?
NO
YES

Do you feel pain in your chest when you do physical activity?

Single choice
NO
YES

In the past month, have you had chest pain when you were NOT doing physical activity?

Single choice
NO
YES

Do you lose balance because of dizziness or do you ever lose consciousness?

Single choice
NO
YES

Do you have a bone or joint problem (for example back, knee or hip)?

Single choice
NO
YES

Is your doctor currently prescribing medication for your blood pressure or heart condition?

Single choice
NO
YES

Do you know of any other reason why you should not take part in physical activity?

Single choice
NO
YES

Do you take any medication, including supplements

Single choice
NO
YES

If you have any additional information you may upload files here, using the "Upload File" button.

add up to 5 files. Most files types supported, with size limitations. If you have difficulty loading files, please contact: info@wowpilates.net

This form and all information within is, Private and Confidential, for use by WOW PILATES only.

Version 1.0  |   January 2026

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