User Registration First Name Last Name Email ParQ We are really pleased that you are joining Fitter For Life wellbeing community and look forward to sharing time, interests and achievements together. The ParQ – is a medical form everybody starting physical activity courses is required to complete and sign. Please take the time to read through and answer each question accurately.Gender Male FemaleDate of Birth Telephone Number AddressAddress Line 1 Address Line 2 City Postcode Please answer the following questions as accurately as you can and provide as much relevant additional information. (If you should answer Yes to any of the questions please provide further information in the space provided).Do you currently have, or have you ever suffered from, or consulted a medical practitioner about any of the following conditions or medical experiences? Heart problems Chest pain Blood pressure problems Stroke Joint movement or joint pain problems Dizziness, faintness or imbalance Currently pregnant or recently given birthIn what way would you like to take the course? As part of a group One-to-one or one-to-two Offline-only i.e self-directedAre you aware of any other reason that may prevent you from taking part in physical activity? Do you currently receive medical care or do any of the following affect or relate to you? If answering yes to any question please provide details Back or spinal pain Headaches or migraines Have you had surgery in the past 2 years? Are you currently prescribed medication? Have you recently finished a course of medication Have diabetes Have asthma or breathing problems Experience breathlessness or tight chest Swollen ankles Palpitations, uneven heartbeat or thumping heart Epilepsy Groin lumps or swelling Recent injuries or illnesses?Submit
