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Alchemy Connected Fitness Ltd - ParQ

Getting to know you and making sure we can provide the best possible service.

This PAR-Q is designed to identify individuals who may require further medical evaluation before starting or continuing an exercise programme at Alchemy Connected Fitness. Please answer the following questions honestly and to the best of your ability. All information is confidential.

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Name

1. Has a doctor ever said that you have a heart condition or high blood pressure, and advised you only to perform medically supervised physical activity?

Yes

2. Do you feel pain in your chest during physical activity?

Yes

3. In the past month, have you had any chest pain while not doing physical activity?

Yes

4. Do you lose balance because of dizziness, or have you ever lost consciousness?

Yes

5. Have you been diagnosed with any other chronic medical condition (other than heart disease or high blood pressure)?

Yes

If yes to above please specify -

6. Are you currently taking any prescribed medications (e.g., for blood pressure, cholesterol, diabetes, asthma)?

Yes

If yes to above please specify -

7. Are there any musculoskeletal or joint problems that could be made worse by a change in physical activity (e.g., knee or hip injuries, back pain)?

Yes

If yes to above please explain -

8. Do you have any current or past injuries, surgeries, or conditions that may affect your ability to exercise?

Yes

If yes to above please specify -

9. In the last 12 months, have you had any significant hospitalisations or prolonged illnesses?

Yes

If yes to above please describe -

10. Have you ever been diagnosed with diabetes or a thyroid condition?

Yes

11. Do you have any history of respiratory issues (e.g., asthma, bronchitis)?

Yes

12. Are you pregnant or is there a possibility you might be pregnant?

Yes

13. Are there any other reasons you might need to consult a doctor before engaging in physical activity (e.g. mental health conditions, fatigue, recent life events)?

Yes

If yes to above please provide details -

14. On average, how many days per week do you engage in any physical activity or exercise?

0–1 day

2–3 days

4–5 days

6–7 days

15. Do you feel any discomfort when performing everyday tasks, such as climbing stairs, carrying groceries, or walking for extended periods?

Yes

If yes to above please specify -

16. Have you experienced any unusual fatigue or shortness of breath during normal daily activities?

Yes

If you answered ‘Yes’ to any of Questions 1–5, we strongly recommend you consult with your GP or specialist before increasing your physical activity level or beginning a new exercise programme. If your health changes so that you could answer YES to any of the above questions, please let us know and seek medical advice immediately. I understand that if I have answered Yes to any of the above questions, I should consult my physician or another qualified medical professional before increasing my physical activity or making changes to my exercise routines. I acknowledge that I fully assume the risk of any injuries, damages, or losses which I may sustain as a result of participation in any programme or services provided by Alchemy Connected Fitness.