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This form is required to be completed ahead of attending a class or personal training with Carin AKA Swedish PT Girl

PAR Q Health form 

Birthday
Do you currently take any medication on a regular basis? If so please specify what.
Yes
No
Has your doctor ever said that you have a heart condition (had a stroke, heart attack, or heart surgery) and/or that you should only do physical activity recommended by a doctor?
Yes
No
Do you feel pain in your chest when you do physical activity?
Yes
No
Do you have high blood pressure? If yes, please advice what it is.
Yes
No
Do you have a diagnosed illness that could be made worse by physical activity?
Yes
No
Do you know of any other reason why you should not do physical activity?
Yes
No
Have you ever been told by a doctor that you have bone, joint, or muscle problems that could be made worse by physical activity?
Yes
No
Date
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