Physical Activity Readiness Questionnaire

Name(Required)
Address(Required)
Has a doctor ever informed you that you have a heart condition or recommended only medically supervised physical activity?(Required)
Do you/have you ever suffered with chest pain brought on by physical activity?(Required)
Have you developed any chest pain during the last four weeks?(Required)
Have you ever lost consciousness or sustained a fall as a result of dizziness?(Required)
Do you suffer with a low back or joint condition that could be aggravated by physical activity?(Required)
Has your GP ever prescribed medication for a blood pressure condition or for a heart condition?(Required)
Has your GP ever recommended that you do not participate in any form of exercise without medical supervision?(Required)

In the event of an emergency please contact

Name(Required)
Address(Required)
Terms & Conditions(Required)
I accept that my body’s reaction to exercise is not totally predictable. Should I develop a condition that affects my ability to exercise, I will inform my Nordic Walking instructor immediately. I take full responsibility for monitoring my own physical condition at all times.
This field is for validation purposes and should be left unchanged.