Parq Health Questionnaire

PARQ: Health Questionnaire Please read the questions carefully and answer separately to the best of your ability, circling the appropriate option or adding information if necessary. Your responses provide of course be kept in the strictest confidence. Personal Details last name:Forename: Date of Birth: / / (dd/mm/yyyy) Sex: phallic Female Home plough: Post Code: Home telephony Number: spry Number: E-Mail Address: Nationality: Which employment do you plan to be break inicipating in? compulsion Contact Details Mr/Mrs/Miss Surname:Forename: Home Address: Post Code:Home Phone Number: Mobile Number:Work Phone Number: Relationship to prospect: Please answer all of the following questions to the best of your knowledge. unit of ammunition the answer that best suits you, and if answering yes to any(prenominal) of the questions, disport intention the space provided to give details if necessary. 1. Has your doctor ever state that you have a heart condition and that you should only do physical legal action on his/her recommendation?

YesNo 2. Do you emotional state disquiet in your chest when you are doing physical activity? YesNo 3. In the past month have you had chest pain whilst not doing physical activity? YesNo 4. Are you shortly pickings medication for a heart condition? YesNoOther If other, please state: 5. Have you ever been diagnosed with any of the following? asthmaDiabetes EpilepsyHigh Blood Pressure 6. Do you suffer from arthritis? YesNo 7. Do you currently consume alcohol above the average per week? (21 Units) YesNo 8. Do you smoke? Yes No 9. How would you describe your physical health at turn in? PoorFairGoodExcellent 10. Can you think of any other reason why you shouldnt take part in... If you want to get a full essay, order it on our website: Orderessay

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